Provider Demographics
NPI:1073911707
Name:SEIBERT, KELLY (OD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:SEIBERT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 RED BANK RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATTI
Mailing Address - State:OH
Mailing Address - Zip Code:45227
Mailing Address - Country:US
Mailing Address - Phone:513-351-0768
Mailing Address - Fax:513-351-9809
Practice Address - Street 1:22 MCINTYRE SQUARE DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-7301
Practice Address - Country:US
Practice Address - Phone:412-364-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-11
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003497152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist