Provider Demographics
NPI:1700969979
Name:SEIDEL, SETH DAVID (OD)
Entity type:Individual
Prefix:DR
First Name:SETH
Middle Name:DAVID
Last Name:SEIDEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR LOCKS
Mailing Address - State:CT
Mailing Address - Zip Code:06096-2326
Mailing Address - Country:US
Mailing Address - Phone:860-623-3727
Mailing Address - Fax:860-623-9510
Practice Address - Street 1:34 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINDSOR LOCKS
Practice Address - State:CT
Practice Address - Zip Code:06096-2326
Practice Address - Country:US
Practice Address - Phone:860-623-3727
Practice Address - Fax:860-623-9510
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT931152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004071825Medicaid
CT490000124Medicare ID - Type Unspecified
CT004071825Medicaid
CT0167950002Medicare NSC