MEDICARE: DR. JOHN CHARLES SPAETH O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	5602T	CA

General Provider Information

NPI Number	:	1033114814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN CHARLES SPAETH O.D.

Provider Business Mailing Address
First Line	:	4945 YORBA RANCH RD
Second Line	:	STE E
City	:	YORBA LINDA
State	:	CA
Zip	:	92887-2553
Country	:	US
Telephone Number	:	714-692-2063
Fax Number	:	714-695-9384

Provider Business Practice Location Address
First Line	:	4945 YORBA RANCH RD
Second Line	:	STE E
City	:	YORBA LINDA
State	:	CA
Zip	:	92887-2553
Country	:	US
Telephone Number	:	714-692-2063
Fax Number	:	714-695-9384

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	12/05/2011

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