Healthcare Provider Details

I. General information

NPI: 1194741165
Provider Name (Legal Business Name): SPECTERA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNITED OPTICAL 6630 SECURITY BLVD
WOODLAWN MD
21207
US

IV. Provider business mailing address

2811 LORD BALTIMORE DR.
BALTIMORE MD
21244
US

V. Phone/Fax

Practice location:
  • Phone: 410-298-4040
  • Fax: 410-298-4167
Mailing address:
  • Phone: 443-316-2101
  • Fax: 410-265-6068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: THOMAS A HEETER
Title or Position: VICE PRESIDENT
Credential:
Phone: 443-316-2061