Provider Demographics
NPI:1679757918
Name:DR ALAN H SIEGEL P A
Entity Type:Organization
Organization Name:DR ALAN H SIEGEL P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:772-335-5006
Mailing Address - Street 1:10692 S US HIGHWAY 1
Mailing Address - Street 2:SUITE B
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-6408
Mailing Address - Country:US
Mailing Address - Phone:772-335-5006
Mailing Address - Fax:772-335-4672
Practice Address - Street 1:10692 S US HIGHWAY 1
Practice Address - Street 2:SUITE B
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-6408
Practice Address - Country:US
Practice Address - Phone:772-335-5006
Practice Address - Fax:772-335-4672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1190152W00000X
FLFL1190332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
91471OtherVCA
111512OtherEYEMED
19745OtherBCBS
3515OtherDAVIS VISION
AH112OtherMEDICARE
SI142924OtherCLARITY
36080OtherGVA
410046674OtherMEDICARE RR
FL4066210001OtherNPPES
5124007OtherAETNA
86030OtherSPECTERA
OP-0001190OtherWORKMAN'S COMP
OP-0001190OtherWORKMAN'S COMP