Provider Demographics
NPI:1427121185
Name:JAMES SEALS PETER TACIA
Entity type:Organization
Organization Name:JAMES SEALS PETER TACIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE BILLER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRAULAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-463-1139
Mailing Address - Street 1:1321 PINE ST
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801
Mailing Address - Country:US
Mailing Address - Phone:989-463-1139
Mailing Address - Fax:989-466-2808
Practice Address - Street 1:1321 PINE AVE
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1242
Practice Address - Country:US
Practice Address - Phone:989-463-1139
Practice Address - Fax:989-466-2808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJS002928152W00000X
MIPT003275152W00000X
MITB003749152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3064217Medicaid
N50060001Medicare ID - Type Unspecified
MI3064217Medicaid