=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649470808
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPAETH, KATZ, MYERS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2007
-----------------------------------------------------
Last Update Date | 07/24/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 37 MEDICAL CROSSING RD
-----------------------------------------------------
City | TAMAQUA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18252-5565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-928-3239
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 840 WALNUT ST SUITE 1110
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19107-5109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-928-3197
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. GEORGE L. SPAETH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 215-928-3239
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------