Provider Demographics
NPI:1912006669
Name:SIEGEL, DONALD JOSEPH (OD)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:JOSEPH
Last Name:SIEGEL
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 1:13540 W CAMINO DEL SOL
Mailing Address - Street 2:SUITE 12
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-4434
Mailing Address - Country:US
Mailing Address - Phone:623-544-3877
Mailing Address - Fax:623-544-3834
Practice Address - Street 1:13540 W CAMINO DEL SOL
Practice Address - Street 2:SUITE 12
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-4434
Practice Address - Country:US
Practice Address - Phone:623-544-3877
Practice Address - Fax:623-544-3834
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1189152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U03044Medicare UPIN
AZZ117495Medicare PIN