Healthcare Provider Details

I. General information

NPI: 1568488690
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

2183 SOUTH TAYLOR ROAD UNITED OPTICAL
UNIVERSITY HEIGHTS OH
44118-3012
US

IV. Provider business mailing address

2811 LORD BALTIMORE DR
BALTIMORE MD
21244
US

V. Phone/Fax

Practice location:
  • Phone: 216-932-9543
  • Fax: 216-932-9651
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 DIRECTOR OF OPTICAL
Credential:
Phone: 443-316-2061