Provider Demographics
NPI:1679017362
Name:SEIBERT MOBILE OPTOMETRY LLC
Entity Type:Organization
Organization Name:SEIBERT MOBILE OPTOMETRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SEIBERT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:502-244-2441
Mailing Address - Street 1:12758 HONEYGROVE CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-4405
Mailing Address - Country:US
Mailing Address - Phone:502-244-2441
Mailing Address - Fax:
Practice Address - Street 1:12910 SHELBYVILLE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1593
Practice Address - Country:US
Practice Address - Phone:502-244-2441
Practice Address - Fax:502-254-4069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02387152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty