MEDICARE: RICHARD SEITH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	055336	GA
2	207W00000X	Ophthalmology Physician	ME97627	FL

General Provider Information

NPI Number	:	1396711511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD SEITH M.D.

Provider Business Mailing Address
First Line	:	1900 MASON AVE STE 100
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-5103
Country	:	US
Telephone Number	:	386-274-5525
Fax Number	:	386-274-5585

Provider Business Practice Location Address
First Line	:	1900 MASON AVE STE 100
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-5103
Country	:	US
Telephone Number	:	386-274-5525
Fax Number	:	386-274-5585

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	12/09/2008

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Directions to “ RICHARD SEITH M.D.” Practice Location

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