Provider Demographics
NPI:1841251741
Name:SEYMOUR, JOHN RAYMOND (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RAYMOND
Last Name:SEYMOUR
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:414 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-1561
Mailing Address - Country:US
Mailing Address - Phone:814-472-4240
Mailing Address - Fax:814-472-4241
Practice Address - Street 1:414 W HIGH ST
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-1561
Practice Address - Country:US
Practice Address - Phone:814-472-4240
Practice Address - Fax:814-472-4241
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0EG000642152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
420181OtherPALMETTO GBA
PA0629370001Medicare NSC
420181OtherPALMETTO GBA