Provider Demographics
NPI:1699779520
Name:SIEGEL, LAWRENCE D (OD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:D
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 EAGLE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-3897
Mailing Address - Country:US
Mailing Address - Phone:781-344-3355
Mailing Address - Fax:
Practice Address - Street 1:300 NEEDHAM ST
Practice Address - Street 2:#4
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02464-1532
Practice Address - Country:US
Practice Address - Phone:617-232-0220
Practice Address - Fax:617-734-9738
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3545152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110016311AMedicaid
MA43755801Medicare PIN
MA110016311AMedicaid