Provider Demographics
NPI:1710189014
Name:DR BARRY P SIEGEL OPTOMETRIST, P.C.
Entity Type:Organization
Organization Name:DR BARRY P SIEGEL OPTOMETRIST, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:773-525-0952
Mailing Address - Street 1:1926 W IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2408
Mailing Address - Country:US
Mailing Address - Phone:773-525-0952
Mailing Address - Fax:773-525-0966
Practice Address - Street 1:1926 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2408
Practice Address - Country:US
Practice Address - Phone:773-525-0952
Practice Address - Fax:773-525-0966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0466370152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL00105852285OtherAETNA
IL046-006370Medicaid
IL046-006370Medicaid
IL046-006370Medicaid
ILU13936Medicare UPIN
ILDP4070Medicare PIN
IL206874Medicare PIN