Provider Demographics
NPI:1710043252
Name:JAMES H SEALS PETER B TACIA & TAD J BARTZ OD PC
Entity Type:Organization
Organization Name:JAMES H SEALS PETER B TACIA & TAD J BARTZ OD PC
Other - Org Name:CARSON CITY OPTICS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-463-1139
Mailing Address - Street 1:1321 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-1242
Mailing Address - Country:US
Mailing Address - Phone:989-463-1139
Mailing Address - Fax:989-466-2808
Practice Address - Street 1:111 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:MI
Practice Address - Zip Code:48811-5122
Practice Address - Country:US
Practice Address - Phone:989-584-6868
Practice Address - Fax:989-584-3006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJS002928152W00000X
MI4901002928152W00000X
MI4901003275152W00000X
MI4901003749152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0788280002Medicare NSC
MIU21050Medicare UPIN
MI0N50060Medicare PIN