Healthcare Provider Details

I. General information

NPI: 1821139965
Provider Name (Legal Business Name): JUDITH UPTEGRAFF SPAETH O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2007
Last Update Date: 10/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6611 BURLINGTON RD
WHITSETT NC
27377-9748
US

IV. Provider business mailing address

6611 BURLINGTON RD
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 Number0896
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: