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Organization

KENT M. SIEBOLDT, OD, PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KENT M. SIEBOLDT OD (PRESIDENT)
(813) 685-2646
Entity
Organization

Contact information

Practice address
324 E BLOOMINGDALE AVE, BRANDON, FL 33511-8155
(813) 685-2646
(813) 681-6821
Mailing address
324 E BLOOMINGDALE AVE, BRANDON, FL 33511-8155
(813) 685-2646
(813) 681-6821

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2120
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
086169300
FL
01
20149
MEDICARE
Enumeration date
02/18/2010
Last updated
02/18/2010
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