Provider Demographics
NPI:1508862616
Name:SIEGEL, FAYE E (OD)
Entity Type:Individual
Prefix:
First Name:FAYE
Middle Name:E
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 1:120 EAGLE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-3897
Mailing Address - Country:US
Mailing Address - Phone:781-344-3355
Mailing Address - Fax:
Practice Address - Street 1:15 BOYLSTON ST
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-1719
Practice Address - Country:US
Practice Address - Phone:617-232-0220
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3335152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA411558Medicare ID - Type Unspecified