MEDICARE: DR. DAVID L. SPIVEY D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TX4208TG	TX

General Provider Information

NPI Number	:	1023002441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID L. SPIVEY D.O.

Provider Business Mailing Address
First Line	:	7125 N BEACH ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-1812
Country	:	US
Telephone Number	:	817-232-2321
Fax Number	:	817-232-4933

Provider Business Practice Location Address
First Line	:	7125 N BEACH ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-1812
Country	:	US
Telephone Number	:	817-232-2321
Fax Number	:	817-232-4933

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	05/25/2010

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