Provider Demographics
NPI:1487900130
Name:SEILER, DAJANA KOMADINA (OD)
Entity type:Individual
Prefix:
First Name:DAJANA
Middle Name:KOMADINA
Last Name:SEILER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:DAJANA
Other - Middle Name:
Other - Last Name:KOMADINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1223 N ROCK RD
Mailing Address - Street 2:BLDG C
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1269
Mailing Address - Country:US
Mailing Address - Phone:316-634-2020
Mailing Address - Fax:
Practice Address - Street 1:1223 N ROCK RD
Practice Address - Street 2:BLDG C
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206
Practice Address - Country:US
Practice Address - Phone:316-634-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1920152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1920OtherOPTOMETRY LICENSE
KS201001510AMedicaid