Provider Demographics
NPI:1184682668
Name:SEELHAMMER, BLAIR GREGORY (OD)
Entity Type:Individual
Prefix:DR
First Name:BLAIR
Middle Name:GREGORY
Last Name:SEELHAMMER
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 1:5167 SCENIC OAK DR SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902
Mailing Address - Country:US
Mailing Address - Phone:507-206-4955
Mailing Address - Fax:507-206-4955
Practice Address - Street 1:111 S BROADWAY
Practice Address - Street 2:STE 101
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904
Practice Address - Country:US
Practice Address - Phone:623-815-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1440152W00000X
MN3135152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ106250Medicare ID - Type UnspecifiedMEDICARE
AZU96253Medicare UPIN