Provider Demographics
NPI:1700957313
Name:SIEGEL, ALAN HOWARD (OD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:HOWARD
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 1:10692 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 1190152W00000X
FL1190332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19745OtherBCBS
SI142924OtherCLARITY VISION
4066210001OtherPALMETTO
FL111512OtherECPA-EYEMED
FL5124007OtherAETNA
91471OtherVCA
3515OtherDAVIS VISION
410046674OtherMEDICARE RR
36080OtherGVA
86030OtherSPECTERA
OP-0001190OtherWORKMANS COMP
91471OtherVCA
FL5124007OtherAETNA