MEDICARE: 152W00000X - OPTOMETRIST NORTH PHOENIX EYE CARE

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

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	:	1649411018
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	152W00000X - OPTOMETRIST NORTH PHOENIX EYE CARE

Provider Business Mailing Address
First Line	:	19401 N CAVE CREEK RD
Second Line	:	#7
City	:	PHOENIX
State	:	AZ
Zip	:	85024-1801
Country	:	US
Telephone Number	:	623-229-8185
Fax Number	:

Provider Business Practice Location Address
First Line	:	19401 N CAVE CREEK RD
Second Line	:	#7
City	:	PHOENIX
State	:	AZ
Zip	:	85024-1801
Country	:	US
Telephone Number	:	623-229-8185
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST/OWNER
Name	:	DR. DONALD JOSEPH SIEGEL
Credential	:	O.D.
Telephone Number	:	623-544-3877

Provider Enumeration Date	:	03/16/2009
Last Update Date	:	03/16/2009

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