Provider Demographics
NPI:1326196569
Name:SEEHOLZER, JEFF H (OD,)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:H
Last Name:SEEHOLZER
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 1:124 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-4526
Mailing Address - Country:US
Mailing Address - Phone:435-752-5334
Mailing Address - Fax:435-752-5349
Practice Address - Street 1:124 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-4526
Practice Address - Country:US
Practice Address - Phone:435-752-5334
Practice Address - Fax:435-752-5349
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT112925-9934152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT0523110001OtherMEDICARE DME