MEDICARE: MR. JOSEPH I SIE 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	1673	NC

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	:	1598762478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH I SIE O.D.

Provider Business Mailing Address
First Line	:	3610 KELWAY AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-4728
Country	:	US
Telephone Number	:	704-554-7394
Fax Number	:

Provider Business Practice Location Address
First Line	:	2120 STATESVILLE BLVD
Second Line	:
City	:	SALISBURY
State	:	NC
Zip	:	28147-1412
Country	:	US
Telephone Number	:	704-636-0559
Fax Number	:

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/24/2008

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