MEDICARE: FAYE E. SIEGEL O.D.

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	3335	MA

General Provider Information

NPI Number	:	1508862616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAYE E. SIEGEL O.D.

Provider Business Mailing Address
First Line	:	120 EAGLE ROCK RD
Second Line	:
City	:	STOUGHTON
State	:	MA
Zip	:	02072-3897
Country	:	US
Telephone Number	:	781-344-3355
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 BOYLSTON ST
Second Line	:
City	:	CHESTNUT HILL
State	:	MA
Zip	:	02467-1719
Country	:	US
Telephone Number	:	617-232-0220
Fax Number	:

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	07/08/2007

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