Eric J. Siesel, O.D.P.C.

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901003938 Issued in MI

Legal business name

ERIC J. SIESEL, O.D.P.C.

Practice address

3265 S. M-129
Sault Sainte Marie, MI 49783

Phone

(906) 635-9347

NPI assigned

Oct 12, 2007

Organization subpart

No

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

Authorized official

Name

Eric SieselNPI 1528053683

Title

President

Phone

(906) 635-9347

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Eric Siesel

  • Optometrist
  • Sault Sainte Marie, MI
  • NPI 1528053683
  Medicare reassignment NPD Authorized official
• Julie Lynn Samu Shouldice, OD

  • Optometrist
  • Indian River, MI
  • NPI 1588742548
  Medicare reassignment NPD
• Brenda Catineau Hart, O.D.

  • Optometrist
  • Fort Myers, FL
  • NPI 1003918442

  MI

  Medicare reassignment NPD

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

{
    "created_epoch": "1192147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330387200000",
    "number": "1407044688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3265 S. M-129",
            "city": "SAULT SAINTE MARIE",
            "state": "MI",
            "postal_code": "49783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3265 S. M-129",
            "city": "SAULT SAINTE MARIE",
            "state": "MI",
            "postal_code": "49783",
            "telephone_number": "906-635-9347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ERIC J. SIESEL, O.D.P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-12",
        "last_updated": "2012-02-28",
        "status": "A",
        "authorized_official_last_name": "SIESEL",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "906-635-9347"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901003938",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "864468052",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "900A765010",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anglea Marie Ellis, LMSW
• Ashly P. Ellis
• Lindsay Ellis
• Mary Ellis
• Nicole Marie Ellison
• Connor L Ernst
• Hannah Mae Erwin, MSOT, OTRL
• Matthew John Fabbro, MD
• Mary Fabis, RD
• Kristin L Fairbanks

• Optometrist in Sault Sainte Marie, MI
• Providers in Sault Sainte Marie, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.