Provider Demographics
NPI:1508885674
Name:SEIDEL, CAMERON (OD)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:
Last Name:SEIDEL
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 1:714 6TH ST
Mailing Address - Street 2:
Mailing Address - City:PROSSER
Mailing Address - State:WA
Mailing Address - Zip Code:99350-1439
Mailing Address - Country:US
Mailing Address - Phone:509-781-6565
Mailing Address - Fax:509-781-6487
Practice Address - Street 1:714 6TH ST
Practice Address - Street 2:
Practice Address - City:PROSSER
Practice Address - State:WA
Practice Address - Zip Code:99350-1439
Practice Address - Country:US
Practice Address - Phone:509-781-6565
Practice Address - Fax:509-781-6487
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60275041152W00000X, 152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2025535Medicaid
WA2025535Medicaid
OR066014Medicaid
012381-0007OtherPACIFICARE/SECURE HORIZON
OR410037066Medicare PIN
OR066014Medicaid
OR410032426Medicare PIN