Healthcare Provider Details

I. General information

NPI: 1265220867
Provider Name (Legal Business Name): AUSTIN WILLIAM-LEE SPOOR AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2025
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N 30TH ST
OMAHA NE
68131-2136
US

IV. Provider business mailing address

5517 S 53RD ST
OMAHA NE
68117-2313
US

V. Phone/Fax

Practice location:
  • Phone: 531-355-1234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: