Provider Demographics
NPI:1659592160
Name:DANIEL D SEIBERT OD PC
Entity Type:Organization
Organization Name:DANIEL D SEIBERT OD PC
Other - Org Name:OVERLAND EYE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:SEIBERT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:314-427-1519
Mailing Address - Street 1:2040 WOODSON RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OVERLAND
Mailing Address - State:MO
Mailing Address - Zip Code:63114-5644
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2040 WOODSON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:OVERLAND
Practice Address - State:MO
Practice Address - Zip Code:63114-5644
Practice Address - Country:US
Practice Address - Phone:314-427-1519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02387152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO310935739Medicaid
MO1659592160OtherGROUP NPI
MO500104104OtherMEDICAID GROUP
MO1962481390OtherNPI DR SEIBERT
MO990001715OtherGROUP MEDICARE
MO1659487387OtherNPI DR ALEXANDEER HARRIS
MO000091331Medicare ID - Type Unspecified
MO410022235Medicare PIN
MO1962481390OtherNPI DR SEIBERT
MO990001715OtherGROUP MEDICARE
MO068801715Medicare ID - Type UnspecifiedDR ALEXANDER HARRIS