Provider Demographics
NPI:1932172152
Name:SIEGRIST, MARGARET MARY (OD)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:MARY
Last Name:SIEGRIST
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 CORPORATE WAY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-2021
Mailing Address - Country:US
Mailing Address - Phone:845-268-0045
Mailing Address - Fax:845-268-0998
Practice Address - Street 1:612 CORPORATE WAY
Practice Address - Street 2:SUITE 3
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-2021
Practice Address - Country:US
Practice Address - Phone:845-268-0045
Practice Address - Fax:845-268-0998
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT 004472152W00000X
NJ4536152W00000X
FLOPC1971152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC40031Medicare ID - Type Unspecified
NYT81540Medicare UPIN