Provider Demographics
NPI:1407648280
Name:SETH TAYLOR OD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SETH TAYLOR OD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEANIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:OLICHWIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-449-8877
Mailing Address - Street 1:9935 COORS BYP NW STE B
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-6195
Mailing Address - Country:US
Mailing Address - Phone:505-899-8993
Mailing Address - Fax:505-898-8994
Practice Address - Street 1:9935 COORS BYP NW STE B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-6195
Practice Address - Country:US
Practice Address - Phone:505-899-8993
Practice Address - Fax:505-898-8994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty