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General NPI Number Information
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NPI Number | 1932141850
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Entity Type | Individual
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Provider Name | MICHAEL JOSEPH SIEBERT OD
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Gender | Male
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 08/20/2021
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Provider Practice Location Address
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Address Line | 205 W BLACKSTOCK RD STE 150
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City | SPARTANBURG
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State | SC
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Zip | 29301-3205
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Country | US
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Telephone | 864-574-8454
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Fax | 864-576-4748
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Provider Business Mailing Address
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Address Line | 1875 HAYNE ST UNIT 224
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City | SPARTANBURG
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State | SC
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Zip | 29301-5108
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Country | US
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Telephone | 305-672-8513
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Fax | 864-576-4748
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1547
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License Number State | SC
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