Healthcare Provider Details

I. General information

NPI: 1033102694
Provider Name (Legal Business Name): FRANK WILLIAM SPAETH OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 05/20/2010
Certification Date:
Deactivation Date: 03/23/2006
Reactivation Date: 03/27/2006

III. Provider practice location address

6611 BURLINGTON RD
WHITSETT NC
27377-9748
US

IV. Provider business mailing address

661 BURLINGTON ROAD
WHITSETT NC
27377-9748
US

V. Phone/Fax

Practice location:
  • Phone: 336-449-1333
  • Fax: 336-449-1348
Mailing address:
  • Phone: 336-449-1333
  • Fax: 336-449-1348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0895
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: