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General NPI Number Information
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NPI Number | 1821722042
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Entity Type | Individual
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Provider Name | JOSHUA DAVID SPEDDING OD
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Gender | Male
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Dates
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Enumeration Date | 07/13/2022
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Last Update Date | 07/13/2022
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Provider Practice Location Address
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Address Line | 1575 20TH ST NW STE 101
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City | FARIBAULT
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State | MN
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Zip | 55021-2931
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Country | US
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Telephone | 507-322-9900
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Fax |
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Provider Business Mailing Address
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Address Line | 318 6TH ST E
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City | NORTHFIELD
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State | MN
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Zip | 55057-2554
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Country | US
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Telephone | 385-424-9928
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Fax |
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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 | 3808
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License Number State | MN
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