Provider Demographics
NPI:1558344671
Name:ASSOCIATE OPTOMETRY, P.A.
Entity Type:Organization
Organization Name:ASSOCIATE OPTOMETRY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SEIBERT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:507-238-4228
Mailing Address - Street 1:1307 ALBION AVE
Mailing Address - Street 2:STE 102 ASSOCIATE OPTOMETRY, P.A.
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-1840
Mailing Address - Country:US
Mailing Address - Phone:507-238-4228
Mailing Address - Fax:507-238-4229
Practice Address - Street 1:1307 ALBION AVE
Practice Address - Street 2:STE. 102 ASSOCIATE OPTOMETRY, P.A.
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-1840
Practice Address - Country:US
Practice Address - Phone:507-238-4228
Practice Address - Fax:507-238-4229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0217152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty