Provider Demographics
NPI:1124194386
Name:SPEISER, SETH (OD)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:
Last Name:SPEISER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19320 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-2936
Mailing Address - Country:US
Mailing Address - Phone:718-357-4666
Mailing Address - Fax:718-357-5676
Practice Address - Street 1:19320 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2936
Practice Address - Country:US
Practice Address - Phone:718-357-4666
Practice Address - Fax:718-357-5676
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005572152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02538Medicare ID - Type Unspecified
NYU53667Medicare UPIN