Provider Demographics
NPI:1437156510
Name:SEIDEL, KARIN (O D)
Entity type:Individual
Prefix:
First Name:KARIN
Middle Name:
Last Name:SEIDEL
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:APT 1
Mailing Address - Street 2:833 BROOKLYN ST
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-8625
Mailing Address - Country:US
Mailing Address - Phone:802-888-5272
Mailing Address - Fax:802-888-5870
Practice Address - Street 1:833 BROOKLYN ST
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-8625
Practice Address - Country:US
Practice Address - Phone:802-888-5272
Practice Address - Fax:802-888-5870
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT030-0000189152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0006605Medicaid
VT1348022001OtherCIGNA
VTVT6605OtherBLUE CROSS
VT0006605Medicaid
VT1348022001OtherCIGNA
VTT25372Medicare UPIN
VT0814880001Medicare NSC