Dr Barry P Siegel Optometrist, P.C.

Primary specialty

OptometristTaxonomy code 152W00000X

License

0466370 Issued in IL

Legal business name

DR BARRY P SIEGEL OPTOMETRIST, P.C.

Practice address

1926 W Irving Park Rd
Chicago, IL 60613-2408

Phone

(773) 525-0952

Fax

(773) 525-0966

NPI assigned

May 31, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Barry Siegel, O.D.

Title

President

Phone

(773) 525-0952

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529539200000",
    "number": "1710189014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1926 W IRVING PARK RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606132408",
            "telephone_number": "773-525-0952",
            "fax_number": "773-525-0966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1926 W IRVING PARK RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606132408",
            "telephone_number": "773-525-0952",
            "fax_number": "773-525-0966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR BARRY P SIEGEL OPTOMETRIST, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-31",
        "last_updated": "2018-06-21",
        "status": "A",
        "authorized_official_last_name": "SIEGEL",
        "authorized_official_first_name": "BARRY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-525-0952",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "0466370",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "00105852285",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046-006370",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2018; 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.