Individual
KELLE SIEGMUND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
10820 N KINGS HWY, MYRTLE BEACH, SC 29572
(843) 467-2060
(843) 692-3094
Mailing address
8068 CORTONA DR, MYRTLE BEACH, SC 29572-8002
(843) 467-2060
(843) 692-3094
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
SC1390
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40924
SPECTERA
SC
05
—
D13901
—
SC
Enumeration date
12/14/2006
Last updated
07/08/2007
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