Individual
PHILIP G SIETSTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
5116 S WESTERN AVE, SIOUX FALLS, SD 57108-2677
(605) 338-7104
(605) 575-3880
Mailing address
5116 S WESTERN AVE, SIOUX FALLS, SD 57108-2677
(605) 338-7104
(605) 575-3880
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
T143
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
410038933
RR MEDICARE
—
01
—
57D35SI
BCBS OF MN
—
05
—
9201122
—
SD
Enumeration date
08/09/2005
Last updated
09/02/2011
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