Provider Demographics
NPI:1427155811
Name:SEAGO, JOHN DURST (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DURST
Last Name:SEAGO
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:422 ORIANA RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-3733
Mailing Address - Country:US
Mailing Address - Phone:757-875-0675
Mailing Address - Fax:757-875-0695
Practice Address - Street 1:1521 SAMS CIR
Practice Address - Street 2:GREGORY JELLENEK AND ASSOC.
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4694
Practice Address - Country:US
Practice Address - Phone:757-436-6546
Practice Address - Fax:757-548-1266
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0618001520152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V04402Medicare UPIN