Provider Demographics
NPI:1235150426
Name:SEELHAMMER OPTICAL, INC.
Entity Type:Organization
Organization Name:SEELHAMMER OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAIR
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:SEELHAMMER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:602-441-5550
Mailing Address - Street 1:17830 N 45TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-9502
Mailing Address - Country:US
Mailing Address - Phone:602-441-5550
Mailing Address - Fax:602-682-7461
Practice Address - Street 1:13660 N 94TH DR STE A2
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4836
Practice Address - Country:US
Practice Address - Phone:623-815-1600
Practice Address - Fax:623-815-1612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1440152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU96253Medicare ID - Type Unspecified