Healthcare Provider Details

I. General information

NPI: 1720256845
Provider Name (Legal Business Name): SEALS TACIA & BARTZ OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25720 COPPER KING WAY
CALUMET MI
49913-2557
US

IV. Provider business mailing address

25720 COPPER KING WAY
CALUMET MI
49913-2557
US

V. Phone/Fax

Practice location:
  • Phone: 906-337-5252
  • Fax: 906-337-5254
Mailing address:
  • Phone: 906-337-5252
  • Fax: 906-337-5254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: CIERRA NIXON
Title or Position: AUTHORIZED MANAGER
Credential:
Phone: 989-584-6868