Provider Demographics
NPI:1255176616
Name:MISKIN, SETH (OD)
Entity type:Individual
Prefix:DR
First Name:SETH
Middle Name:
Last Name:MISKIN
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 1:630 9TH ST
Mailing Address - Street 2:
Mailing Address - City:FORTUNA
Mailing Address - State:CA
Mailing Address - Zip Code:95540-2324
Mailing Address - Country:US
Mailing Address - Phone:707-725-5144
Mailing Address - Fax:707-725-3511
Practice Address - Street 1:630 9TH ST
Practice Address - Street 2:
Practice Address - City:FORTUNA
Practice Address - State:CA
Practice Address - Zip Code:95540-2324
Practice Address - Country:US
Practice Address - Phone:707-725-5144
Practice Address - Fax:707-725-3511
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35805152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist