# EARLENE C. SIEBOLD M.D.P.C,

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215312160
- **Authorized official:** DR. EARLENE C SIEBOLD MD (PHYSICIAN)
- **Authorized official phone:** (585) 244-5630

## Contact information

- **Practice address:** 880 WESTFALL RD, SUITE A, ROCHESTER, NY 14618-2611
- **Practice address phone:** (585) 244-5630
- **Practice address fax:** (585) 487-8250
- **Mailing address:** 880 WESTFALL RD STE A, ROCHESTER, NY 14618-2611
- **Mailing address phone:** (585) 244-5630

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | 156287 | NY | Yes |

## Other

- **Enumeration date:** 07/21/2015
- **Last updated:** 06/28/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 01093163 | — | NY |
| 01 | — | 1045398 | CAQH | NY |
| 01 | — | BB8505 | PTAN | — |