Provider Demographics
NPI:1508198482
Name:ELIOT SIEGEL MD INC
Entity Type:Organization
Organization Name:ELIOT SIEGEL MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIOT
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-829-1224
Mailing Address - Street 1:1301 20TH ST
Mailing Address - Street 2:SUITE 260
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2052
Mailing Address - Country:US
Mailing Address - Phone:310-829-1224
Mailing Address - Fax:310-315-0133
Practice Address - Street 1:1301 20TH ST
Practice Address - Street 2:SUITE 260
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2052
Practice Address - Country:US
Practice Address - Phone:310-829-1224
Practice Address - Fax:310-315-0133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39748207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty