1841280542 NPI number — JEFFREY LEE SPAHR O.D.

Table of content: JEFFREY LEE SPAHR O.D. (NPI 1841280542)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841280542 NPI number — JEFFREY LEE SPAHR O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPAHR
Provider First Name:
JEFFREY
Provider Middle Name:
LEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841280542
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8098 CLEAR WATER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONE TREE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80124-3073
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-781-5152
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3350 S BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80113-2428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-781-5152
Provider Business Practice Location Address Fax Number:
303-781-7441
Provider Enumeration Date:
10/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OPT 1538 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4467973 . This is a "AETNA PPO/POS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: CO1538 . This is a "EYEMED" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 29513 . This is a "EYE CARE NETWORK" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 920350 . This is a "BLOCK VISION INC." identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 2233944 . This is a "AETNA HMO" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 08915381 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 132051 . This is a "COLE MANAGED VISION" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 43503 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com