Provider Demographics
NPI:1366856981
Name:SIEGEL, RACHEL (OD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:SIEGEL
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 1:5320 E MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2573
Mailing Address - Country:US
Mailing Address - Phone:614-863-1433
Mailing Address - Fax:
Practice Address - Street 1:5320 E MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2573
Practice Address - Country:US
Practice Address - Phone:614-863-1433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6317152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist