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General NPI Number Information
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NPI Number | 1164933115
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Entity Type | Organization
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Legal Business Name | SEYMOUR VISION LLC
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Dates
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Enumeration Date | 10/17/2017
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Last Update Date | 11/12/2019
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Provider Practice Location Address
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Address Line | 343 BEACH ST APT 506
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City | WEST HAVEN
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State | CT
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Zip | 06516-6172
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Country | US
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Telephone | 707-318-3451
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Fax |
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Provider Business Mailing Address
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Address Line | 343 BEACH ST APT 506
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City | WEST HAVEN
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State | CT
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Zip | 06516-6172
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Country | US
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Telephone | 707-318-3451
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | TARA SEYMOUR
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Credential | O.D.
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Telephone | 707-318-3451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2949
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License Number State | CT
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