MEDICARE: BRUCE M SIEGLING OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	118	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487674305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE M SIEGLING OD

Provider Business Mailing Address
First Line	:	310 8TH AVE NW STE 503
Second Line	:
City	:	ABERDEEN
State	:	SD
Zip	:	57401-2369
Country	:	US
Telephone Number	:	605-225-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	1520 4TH ST NE
Second Line	:
City	:	WATERTOWN
State	:	SD
Zip	:	57201-6824
Country	:	US
Telephone Number	:	605-882-1818
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	11/30/2007

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