1679757918 NPI number — DR ALAN H SIEGEL P A

Table of content: (NPI 1679757918)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679757918 NPI number — DR ALAN H SIEGEL P A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR ALAN H SIEGEL P A
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679757918
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10692 S US HIGHWAY 1
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
PORT ST LUCIE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34952-6408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-335-5006
Provider Business Mailing Address Fax Number:
772-335-4672

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10692 S US HIGHWAY 1
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
PORT ST LUCIE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34952-6408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-335-5006
Provider Business Practice Location Address Fax Number:
772-335-4672
Provider Enumeration Date:
12/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SIEGEL
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
HOWARD
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
772-335-5006

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OPC1190 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332H00000X , with the licence number: FL1190 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 91471 . This is a "VCA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 111512 . This is a "EYEMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 19745 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3515 . This is a "DAVIS VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: AH112 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: SI142924 . This is a "CLARITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 36080 . This is a "GVA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 410046674 . This is a "MEDICARE RR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4066210001 . This is a "NPPES" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 5124007 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 86030 . This is a "SPECTERA" identifier . This identifiers is of the category "OTHER".
  • Identifier: OP-0001190 . This is a "WORKMAN'S COMP" identifier . This identifiers is of the category "OTHER".




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