Provider Demographics
NPI:1558048728
Name:SEIDER, MARISSA RENEE (OD)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:RENEE
Last Name:SEIDER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3768 COOMER RD
Mailing Address - Street 2:
Mailing Address - City:NEWFANE
Mailing Address - State:NY
Mailing Address - Zip Code:14108-9617
Mailing Address - Country:US
Mailing Address - Phone:716-343-3207
Mailing Address - Fax:
Practice Address - Street 1:2825 NIAGARA FALLS BLVD STE 130
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2021
Practice Address - Country:US
Practice Address - Phone:716-564-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009849152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist