Provider Demographics
NPI:1295177632
Name:SEILHEIMER, JOHN BRENT
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:BRENT
Last Name:SEILHEIMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 N MAIN ST STE D
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-6816
Mailing Address - Country:US
Mailing Address - Phone:575-622-3364
Mailing Address - Fax:
Practice Address - Street 1:3020 N MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-6816
Practice Address - Country:US
Practice Address - Phone:575-622-3364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-26
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician