Individual
DR. BARRY P SIEGEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1926 W IRVING PARK RD, CHICAGO, IL 60613-2408
(773) 525-0952
(773) 525-0966
Mailing address
1926 W IRVING PARK RD, CHICAGO, IL 60613-2408
(773) 525-0952
(773) 525-0966
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046-006370
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00105852285
AETNA
—
05
—
046-006370
—
IL
01
—
206874
MEDICARE GROUP ID
—
01
—
363727344
TAX ID
—
Enumeration date
07/13/2005
Last updated
01/06/2014
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