Healthcare Provider Details

I. General information

NPI: 1962481390
Provider Name (Legal Business Name): DANIEL D SEIBERT O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 04/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 WOODSON RD SUITE 100
OVERLAND MO
63114-3629
US

IV. Provider business mailing address

2040 WOODSON RD SUITE 100
OVERLAND MO
63114-5644
US

V. Phone/Fax

Practice location:
  • Phone: 314-427-1519
  • Fax: 314-427-1522
Mailing address:
  • Phone: 314-427-1519
  • Fax: 314-427-1522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT02387
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: