Provider Demographics
NPI:1548312010
Name:SIEDMAN, PETER S (OD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:S
Last Name:SIEDMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7107 LAKE WORTH RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2906
Mailing Address - Country:US
Mailing Address - Phone:561-966-2212
Mailing Address - Fax:561-966-2215
Practice Address - Street 1:7107 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2906
Practice Address - Country:US
Practice Address - Phone:561-966-2212
Practice Address - Fax:561-966-2215
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4066152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist