Provider Demographics
NPI:1144390170
Name:SIEGEL, DAVID ALLAN (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALLAN
Last Name:SIEGEL
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 1:91 LAKES RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-2613
Mailing Address - Country:US
Mailing Address - Phone:845-783-1224
Mailing Address - Fax:845-783-3905
Practice Address - Street 1:91 LAKES RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-2613
Practice Address - Country:US
Practice Address - Phone:845-783-1224
Practice Address - Fax:845-783-3905
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV3923152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT81530Medicare UPIN
NYWEU431Medicare ID - Type Unspecified