Provider Demographics
NPI:1225034325
Name:SIEGEL, ARTHUR LEONARD (OD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:LEONARD
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 1:25 HOMESTEAD DR STE A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NJ
Mailing Address - Zip Code:08022-1005
Mailing Address - Country:US
Mailing Address - Phone:609-298-0888
Mailing Address - Fax:609-291-1972
Practice Address - Street 1:25 HOMESTEAD DR STE A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NJ
Practice Address - Zip Code:08022-1005
Practice Address - Country:US
Practice Address - Phone:609-298-0888
Practice Address - Fax:609-291-1972
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27TO00032203152WL0500X
NJ27OA00355100152W00000X, 152WL0500X
NJ27OA00355104152W00000X, 152WL0500X
PAOE008512P152W00000X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0252603Medicaid
NJT93198Medicare UPIN
NJ669058BK7Medicare PIN
NJ0252603Medicaid
NJ410043571Medicare PIN