Provider Demographics
NPI:1992795678
Name:SEIFERT, GLENN
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:
Last Name:SEIFERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SPRINGVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-2290
Mailing Address - Country:US
Mailing Address - Phone:631-728-3132
Mailing Address - Fax:631-728-0976
Practice Address - Street 1:4 SPRINGVILLE RD
Practice Address - Street 2:
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-2290
Practice Address - Country:US
Practice Address - Phone:631-728-3132
Practice Address - Fax:631-728-0976
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT003485-1152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC27611Medicare ID - Type Unspecified
NYT49070Medicare UPIN