Provider Demographics
NPI:1366604548
Name:SUMMERFIELD OPTICIANS
Entity type:Organization
Organization Name:SUMMERFIELD OPTICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SEELEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-579-8093
Mailing Address - Street 1:4739 HOEN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-7862
Mailing Address - Country:US
Mailing Address - Phone:707-579-8093
Mailing Address - Fax:707-544-2734
Practice Address - Street 1:4739 HOEN AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-7862
Practice Address - Country:US
Practice Address - Phone:707-579-8093
Practice Address - Fax:707-544-2734
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIEN A. SEELEY, M. D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27860156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1002870001Medicare PIN