Healthcare Provider Details

I. General information

NPI: 1063484731
Provider Name (Legal Business Name): THOMAS WALTER SEAMAN OPTICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3948 TOWN CENTER BLVD
ORLANDO FL
32837
US

IV. Provider business mailing address

3948 TOWN CENTER BLVD
ORLANDO FL
32837
US

V. Phone/Fax

Practice location:
  • Phone: 407-856-7000
  • Fax: 407-856-4647
Mailing address:
  • Phone: 407-856-7000
  • Fax: 407-856-4647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number2736
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: