Provider Demographics
NPI:1326397555
Name:SIRI, ELEANOR (OD)
Entity Type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:
Last Name:SIRI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 CAMBRIDGE PLZ
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-2531
Mailing Address - Country:US
Mailing Address - Phone:443-225-5377
Mailing Address - Fax:833-940-2191
Practice Address - Street 1:724 CAMBRIDGE PLZ
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-2531
Practice Address - Country:US
Practice Address - Phone:443-225-5377
Practice Address - Fax:833-940-2191
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-04
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2601152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC036061400Medicaid