Healthcare Provider Details

I. General information

NPI: 1467664151
Provider Name (Legal Business Name): DONALD HUNTLEY SPAULDING O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

944 W FOOTHILL BLVD STE A
UPLAND CA
91786-3757
US

IV. Provider business mailing address

944 W FOOTHILL BLVD STE A
UPLAND CA
91786-3757
US

V. Phone/Fax

Practice location:
  • Phone: 909-982-3040
  • Fax: 909-982-5996
Mailing address:
  • Phone: 909-982-3040
  • Fax: 909-982-5996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6810-T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: