Provider Demographics
NPI:1962481390
Name:SEIBERT, DANIEL D (OD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:D
Last Name:SEIBERT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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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:314-427-1519
Mailing Address - Fax:314-427-1522
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:63114-3629
Practice Address - Country:US
Practice Address - Phone:314-427-1519
Practice Address - Fax:314-427-1522
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOT02387152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO310935739Medicaid
MO990001715OtherGROUP MEDICARE
MO500104104OtherMEDICAID GROUP
MO1962481390OtherNPI DR SEIBERT
MO1659592160OtherGROUP NPI
MO410022235Medicare PIN
MODH0144Medicare PIN
MO1659592160OtherGROUP NPI
MOMA6568001Medicare PIN
MO1962481390OtherNPI DR SEIBERT
MO310935739Medicaid
MOMA5057007Medicare PIN