Provider Demographics
NPI:1235320680
Name:SEES, THEODORE FRANCIS (OD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:FRANCIS
Last Name:SEES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:TED
Other - Middle Name:FRANCIS
Other - Last Name:SEES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:2745 10 MILE RD NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-9146
Mailing Address - Country:US
Mailing Address - Phone:616-951-7115
Mailing Address - Fax:616-951-7112
Practice Address - Street 1:2745 10 MILE RD NE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-9146
Practice Address - Country:US
Practice Address - Phone:616-951-7115
Practice Address - Fax:616-951-7112
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2067152W00000X
MI4901004807152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4901004807Medicaid
MI4901004807Medicaid
MDTA2067Medicare Oscar/Certification
MDTA2067Medicare PIN