Philip G Sietstra, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

T143 Issued in SD

Practice address

5116 S Western Ave
Sioux Falls, SD 57108-2677

Phone

(605) 338-7104

Fax

(605) 575-3880

NPI assigned

Aug 9, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314921600000",
    "number": "1376544833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5116 S WESTERN AVE",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571082677",
            "telephone_number": "605-338-7104",
            "fax_number": "605-575-3880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5116 S WESTERN AVE",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571082677",
            "telephone_number": "605-338-7104",
            "fax_number": "605-575-3880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIETSTRA",
        "first_name": "PHILIP",
        "middle_name": "G",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-09",
        "last_updated": "2011-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SD",
            "license": "T143",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "410038933",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9201122",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MN",
            "identifier": "57D35SI",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Renee Marie Siegmann, M.D.
• Angela Rae Sieh Ceretto, MA, CCC-A, FAAA
• Amy L Sieh, RN
• Ruth Ann Siem, PA-C
• Anthony A Sierra, M.D.
• Mary Sieve
• Delaina Patricia Sievers, PA-C
• Gail A Sievert, CRNA
• Annette Lee Siewert, M.D.
• Sigaty Dental Clinic PC

• Optometrist in Sioux Falls, SD
• Providers in Sioux Falls, SD by specialty
• Optometrist in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.