Provider Demographics
NPI:1861559619
Name:JAMES H SEALS PETER B TACIA & TAD J BARTZ OD PC
Entity type:Organization
Organization Name:JAMES H SEALS PETER B TACIA & TAD J BARTZ OD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIEDEMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-773-7747
Mailing Address - Street 1:1321 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-1242
Mailing Address - Country:US
Mailing Address - Phone:989-463-1139
Mailing Address - Fax:989-466-2808
Practice Address - Street 1:2865 S LINCOLN RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-9085
Practice Address - Country:US
Practice Address - Phone:989-773-7747
Practice Address - Fax:989-779-1068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003749152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900B910180OtherBLUE CROSS OF MICHIGAN
MI0N50060Medicare PIN
MI900B910180OtherBLUE CROSS OF MICHIGAN