Provider Demographics
NPI:1558356162
Name:SIETMANN, PAUL J (OD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:SIETMANN
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 1:10363 FERRY FARM LN
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-6955
Mailing Address - Country:US
Mailing Address - Phone:214-886-8013
Mailing Address - Fax:
Practice Address - Street 1:10363 FERRY FARM LN
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-6955
Practice Address - Country:US
Practice Address - Phone:214-886-8013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2017-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3849TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU0138Medicare UPIN
TX8B8424Medicare PIN