Provider Demographics
NPI:1598858672
Name:SIEFFERT, ROBERT N (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:N
Last Name:SIEFFERT
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 1:522 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29631-1443
Mailing Address - Country:US
Mailing Address - Phone:864-654-3685
Mailing Address - Fax:864-654-3695
Practice Address - Street 1:522 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-1443
Practice Address - Country:US
Practice Address - Phone:864-654-3685
Practice Address - Fax:864-654-3695
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC525152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD05251Medicaid
SC0470230001Medicare NSC
SCD05251Medicaid