Provider Demographics
NPI:1083716971
Name:SEIM, TERESA M (OD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:M
Last Name:SEIM
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 1:52883 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MATTAWAN
Mailing Address - State:MI
Mailing Address - Zip Code:49071-8309
Mailing Address - Country:US
Mailing Address - Phone:269-668-5558
Mailing Address - Fax:
Practice Address - Street 1:52883 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MATTAWAN
Practice Address - State:MI
Practice Address - Zip Code:49071-8309
Practice Address - Country:US
Practice Address - Phone:269-668-5558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003899152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4474499Medicaid
MION63150Medicare ID - Type Unspecified
MI4474499Medicaid