Provider Demographics
NPI:1144518127
Name:SEDDIO, DANIELLE R (OD)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:R
Last Name:SEDDIO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:DANIELLE
Other - Middle Name:R
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:6658 ODANA RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1012
Mailing Address - Country:US
Mailing Address - Phone:608-829-3937
Mailing Address - Fax:608-831-2330
Practice Address - Street 1:6658 ODANA RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1012
Practice Address - Country:US
Practice Address - Phone:608-829-3937
Practice Address - Fax:608-831-2330
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3330-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1144518127Medicaid
MO0360070001Medicare NSC
MO064380029Medicare PIN