=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598831950
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. FRANK W. SPAETH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2006
-----------------------------------------------------
Last Update Date | 09/09/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6611 BURLINGTON RD
-----------------------------------------------------
City | WHITSETT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27377-9748
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-449-1333
-----------------------------------------------------
Fax | 336-449-1348
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6611 BURLINGTON RD
-----------------------------------------------------
City | WHITSETT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27377-9748
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-449-1333
-----------------------------------------------------
Fax | 336-449-1348
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. FRANK WILLIAM SPAETH
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 336-449-1333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 0895
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------