Individual
JASON SIEGMUND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
540 SEABOARD ST, MYRTLE BEACH, SC 29577
(843) 626-6210
(843) 692-3094
Mailing address
8077 VERONA DR, MYRTLE BEACH, SC 29572-8001
(843) 626-6210
(843) 692-3094
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
SC1389
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
41155
SPECTERA
SC
05
—
D13894
—
SC
Enumeration date
12/14/2006
Last updated
01/09/2015
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