Provider Demographics
NPI:1366622383
Name:BRIEN A SEELEY M.D., INC
Entity type:Organization
Organization Name:BRIEN A SEELEY M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
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:707-544-2720
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:707-544-2720
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:707-544-2720
Practice Address - Fax:707-544-2734
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIEN A SEELEY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-07
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27860207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ05961ZMedicare PIN
CAA43523Medicare UPIN