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General NPI Number Information
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NPI Number | 1124436464
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Entity Type | Individual
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Provider Name | DAVID ANDREW SPANDE O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/31/2014
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Last Update Date | 02/24/2021
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Provider Practice Location Address
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Address Line | 1300 UNIVERSITY AVE W OPTICAL CLINIC
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City | SAINT PAUL
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State | MN
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Zip | 55104-4103
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Country | US
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Telephone | 651-641-6181
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Fax | 651-646-3292
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Provider Business Mailing Address
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Address Line | 1300 UNIVERSITY AVE W OPTICAL CLINIC
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City | SAINT PAUL
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State | MN
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Zip | 55104-4103
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Country | US
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Telephone | 651-641-6181
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Fax | 651-646-3292
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC4881
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT-002475
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3360
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License Number State | MN
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