Healthcare Provider Details

I. General information

NPI: 1386814168
Provider Name (Legal Business Name): SEEHOLZER VISION CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 N MAIN STREET
LOGAN UT
84321
US

IV. Provider business mailing address

124 N MAIN ST
LOGAN UT
84321-4526
US

V. Phone/Fax

Practice location:
  • Phone: 435-752-5334
  • Fax: 435-752-5949
Mailing address:
  • Phone: 435-752-5334
  • Fax: 435-752-5349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number112925-9934
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number112925-9934
License Number StateUT

VIII. Authorized Official

Name: DR. JEFF H SEEHOLZER
Title or Position: OWNER
Credential: OD
Phone: 435-752-5334