Provider Demographics
NPI:1154418564
Name:SEIPEL, MARK H (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:H
Last Name:SEIPEL
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Gender:M
Credentials:OD
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Mailing Address - Street 1:7525 TIDEWATER DR
Mailing Address - Street 2:SUITE 41
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-3700
Mailing Address - Country:US
Mailing Address - Phone:757-588-5423
Mailing Address - Fax:757-588-6012
Practice Address - Street 1:7525 TIDEWATER DR
Practice Address - Street 2:SUITE 41
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-3700
Practice Address - Country:US
Practice Address - Phone:757-588-5423
Practice Address - Fax:757-588-6012
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2010-06-09
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Provider Licenses
StateLicense IDTaxonomies
VA0618000125152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9234861Medicaid
VA0322710001Medicare NSC
VA410000188Medicare ID - Type Unspecified
VA9234861Medicaid