Organization
JOHN C SIEGLTIZ
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN C SIEGLTIZ O.D. (OWNER)
(812) 427-2717
Entity
Organization
Contact information
Practice address
121 W MAIN ST, VEVAY, IN 47043-1125
(812) 427-2717
(812) 427-3265
Mailing address
PO BOX 96, VEVAY, IN 47043-0096
(812) 427-2717
(812) 427-3265
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18001358A
IN
152W00000X
Optometrist
18003584A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200336980A
—
IN
05
—
200950880A
—
IN
Enumeration date
10/30/2009
Last updated
10/30/2009
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