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General NPI Number Information
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NPI Number | 1851758346
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Entity Type | Organization
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Legal Business Name | SPECTERA, INC.
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Dates
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Enumeration Date | 01/28/2016
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Last Update Date | 01/28/2016
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Provider Practice Location Address
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Address Line | 2111 VAN DEMAN ST
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City | BALTIMORE
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State | MD
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Zip | 21224-6609
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Country | US
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Telephone | 410-631-2840
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Fax |
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Provider Business Mailing Address
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Address Line | 6220 OLD DOBBIN LN
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City | COLUMBIA
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State | MD
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Zip | 21045-5812
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DEPUTY GENERAL COUNSEL MGR
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Name | JENNIFER LEWIS-DAVID
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Credential |
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Telephone | 443-896-0623
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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