Provider Demographics
NPI:1649411018
Name:152W00000X - OPTOMETRIST NORTH PHOENIX EYE CARE
Entity Type:Organization
Organization Name:152W00000X - OPTOMETRIST NORTH PHOENIX EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:623-544-3877
Mailing Address - Street 1:19401 N CAVE CREEK RD
Mailing Address - Street 2:#7
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-1801
Mailing Address - Country:US
Mailing Address - Phone:623-229-8185
Mailing Address - Fax:
Practice Address - Street 1:19401 N CAVE CREEK RD
Practice Address - Street 2:#7
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-1801
Practice Address - Country:US
Practice Address - Phone:623-229-8185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUN CITY WEST EYE CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ627713Medicaid
AZ627713Medicaid