1912963570 NPI number — DR. PAUL FRANKLIN SPEESLER O.D.

Table of content: DR. PAUL FRANKLIN SPEESLER O.D. (NPI 1912963570)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912963570 NPI number — DR. PAUL FRANKLIN SPEESLER O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPEESLER
Provider First Name:
PAUL
Provider Middle Name:
FRANKLIN
Provider Name Prefix Text:
DR.
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:
SPEESLER
Provider Other First Name:
PAUL
Provider Other Middle Name:
FRANKLIN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1912963570
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1925 CHESTNUT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19103-3534
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-854-0441
Provider Business Mailing Address Fax Number:
215-568-0661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2801 N. 22ND. ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-226-0355
Provider Business Practice Location Address Fax Number:
215-226-1056
Provider Enumeration Date:
04/24/2006

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: 152WC0802X , with the licence number:  OET008973 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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