Healthcare Provider Details

I. General information

NPI: 1982751624
Provider Name (Legal Business Name): JOHN WILLIAM SPALLONE JR. O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 DIVISADERO ST SUITE 400A
SAN FRANCISCO CA
94115-3036
US

IV. Provider business mailing address

1635 DIVISADERO ST SUITE 400A
SAN FRANCISCO CA
94115-3036
US

V. Phone/Fax

Practice location:
  • Phone: 415-833-2020
  • Fax: 415-833-2609
Mailing address:
  • Phone: 415-833-2020
  • Fax: 415-833-2609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number07355T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: