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General NPI Number Information
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NPI Number | 1619184504
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Entity Type | Organization
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Legal Business Name | DR. TIM R. SEIFERT, OPTOMETRIST, S.C.
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 02/22/2008
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Provider Practice Location Address
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Address Line | 211 COTTONWOOD AVE
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City | HARTLAND
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State | WI
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Zip | 53029-2016
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Country | US
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Telephone | 262-367-6610
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Fax |
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Provider Business Mailing Address
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Address Line | 211 COTTONWOOD AVE
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City | HARTLAND
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State | WI
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Zip | 53029-2016
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Country | US
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Telephone | 262-367-6610
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Fax |
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Authorized Official
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Title or Position | PRESIDENT OF S.C.
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Name | DR. TIM R. SEIFERT
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Credential | O.D.
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Telephone | 262-367-6610
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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 | 1488
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License Number State | WI
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