Provider Demographics
NPI:1699745174
Name:SEIBERT, DONALD ALAN (OD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:ALAN
Last Name:SEIBERT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 OAK LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25704-9393
Mailing Address - Country:US
Mailing Address - Phone:304-617-3785
Mailing Address - Fax:304-757-8883
Practice Address - Street 1:#7 PUTNAM VILLAGE
Practice Address - Street 2:
Practice Address - City:TEAYS VALLEY
Practice Address - State:WV
Practice Address - Zip Code:25569
Practice Address - Country:US
Practice Address - Phone:304-757-8883
Practice Address - Fax:304-757-8883
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV898-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0150033000Medicaid