MEDICARE: DR. CHARLOTTE IRENE SPADA OD

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	11021	TX
2	152WL0500X	Low Vision Rehabilitation Optometrist	11021	TX

General Provider Information

NPI Number	:	1114793155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLOTTE IRENE SPADA OD

Provider Business Mailing Address
First Line	:	9725 DATAPOINT DR # 69
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-2384
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2547 E COMMERCE ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78203-1907
Country	:	US
Telephone Number	:	210-619-7020
Fax Number	:

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

Provider Enumeration Date	:	11/30/2023
Last Update Date	:	11/30/2023

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