Basic Information
Provider Information
NPI: 1982778825
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SZELIGA
FirstName: ROBERT
MiddleName: REISS
NamePrefix: DR.
NameSuffix:  
Credential: O.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5238 MAIN ST
Address2:  
City: SPRING HILL
State: TN
PostalCode: 371742443
CountryCode: US
TelephoneNumber: 9314891950
FaxNumber: 9314891953
Practice Location
Address1: 5238 MAIN ST
Address2:  
City: SPRING HILL
State: TN
PostalCode: 371742443
CountryCode: US
TelephoneNumber: 9314891950
FaxNumber: 9314891953
Other Information
ProviderEnumerationDate: 11/20/2006
LastUpdateDate: 09/12/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
152W00000X2599TNY Eye and Vision Services ProvidersOptometrist 

No ID Information.


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