Provider Demographics
NPI:1962546929
Name:LAWRENCE D. SIEGEL, O.D., LLC
Entity type:Organization
Organization Name:LAWRENCE D. SIEGEL, O.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:617-232-0220
Mailing Address - Street 1:300 NEEDHAM ST
Mailing Address - Street 2:# 4
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02464-1532
Mailing Address - Country:US
Mailing Address - Phone:617-232-0220
Mailing Address - Fax:617-734-9738
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3545152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110083510AMedicaid