Provider Demographics
NPI:1760550123
Name:SEADER, BRIAN R (OD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:R
Last Name:SEADER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4253 MONTGOMERY BLVD NE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1106
Mailing Address - Country:US
Mailing Address - Phone:505-883-2550
Mailing Address - Fax:505-881-8931
Practice Address - Street 1:4253 MONTGOMERY BLVD NE
Practice Address - Street 2:STE 110
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1113
Practice Address - Country:US
Practice Address - Phone:505-883-2550
Practice Address - Fax:505-881-8931
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM578152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP00893453Medicare PIN
NM346708102Medicare PIN
NMV11543Medicare UPIN
NM0598510001Medicare NSC