Provider Demographics
NPI:1356587877
Name:SEIDEL EYECARE CENTER, PLLC
Entity type:Organization
Organization Name:SEIDEL EYECARE CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:
Authorized Official - Last Name:SEIDEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:817-371-7336
Mailing Address - Street 1:1314 NW JOHN JONES DR
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-8040
Mailing Address - Country:US
Mailing Address - Phone:817-349-4485
Mailing Address - Fax:817-349-4489
Practice Address - Street 1:1314 NW JOHN JONES DR
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-8040
Practice Address - Country:US
Practice Address - Phone:817-349-4485
Practice Address - Fax:817-349-4489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-06
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6869T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty