Active NPI
Timothy Howard Seidlitz, O.D.
- Optometrist
- Dunsmuir, CA
National Provider Identifier
1215037908
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- CA7762T
- Practice address
- 4305 Stagecoach Rd
Dunsmuir, CA 96025-1812 - Phone
- (530) 235-2190
- Fax
- (530) 235-2734
- NPI assigned
- Sep 23, 2006
- Last updated
- Jun 5, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | CA7762T | CA | Primary |
Addresses
Primary practice location
4305 Stagecoach Rd
Dunsmuir, CA 96025-1812
Mailing address
PO Box 407
Dunsmuir, CA 96025-0407
Phone (530) 235-2190
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SD0077620 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CA7762T | CA | MD | Optometrist |
| 7762 | CA | MD | Speech-Language Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158969600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1338854400000",
"number": "1215037908",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 407",
"city": "DUNSMUIR",
"state": "CA",
"postal_code": "960250407",
"telephone_number": "530-235-2190",
"fax_number": "530-235-2734"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4305 STAGECOACH RD",
"city": "DUNSMUIR",
"state": "CA",
"postal_code": "960251812",
"telephone_number": "530-235-2190",
"fax_number": "530-235-2734"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SEIDLITZ",
"first_name": "TIMOTHY",
"middle_name": "HOWARD",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-23",
"last_updated": "2012-06-05",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "CA7762T",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "SD0077620",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dunsmuir, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.