MEDICARE: DR. BRIEN A. SEELEY 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	207W00000X	Ophthalmology Physician	G27860	CA

General Provider Information

NPI Number	:	1972566842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIEN A. SEELEY M.D.

Provider Business Mailing Address
First Line	:	4739 HOEN AVE
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95405-7862
Country	:	US
Telephone Number	:	707-544-2720
Fax Number	:	707-544-2734

Provider Business Practice Location Address
First Line	:	4739 HOEN AVE
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95405-7862
Country	:	US
Telephone Number	:	707-544-2720
Fax Number	:	707-544-2734

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

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	03/13/2008

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