Provider Demographics
NPI:1669592440
Name:SIERON, CRAIG A (OD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:A
Last Name:SIERON
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 1:5308 WEST MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226
Mailing Address - Country:US
Mailing Address - Phone:618-257-9800
Mailing Address - Fax:618-355-7800
Practice Address - Street 1:5308 WEST MAIN ST.
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226
Practice Address - Country:US
Practice Address - Phone:618-257-9800
Practice Address - Fax:618-355-7800
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046007892152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL172995OtherMEDICARE RENDERING NUMBER
IL0388550001Medicare NSC
IL172961Medicare ID - Type UnspecifiedM EDICARE RENDING NUMBER
IL556550Medicare Oscar/Certification
ILL72995Medicare UPIN
IL556830Medicare Oscar/Certification
0388550001Medicare NSC