MEDICARE: DR. DAISY LEE SPEARMAN 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	6852	CA

General Provider Information

NPI Number	:	1487283362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAISY LEE SPEARMAN OD

Provider Business Mailing Address
First Line	:	PO BOX 45556
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-0556
Country	:	US
Telephone Number	:	213-999-6683
Fax Number	:

Provider Business Practice Location Address
First Line	:	5136 W SLAUSON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90056-1641
Country	:	US
Telephone Number	:	213-999-6683
Fax Number	:

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

Provider Enumeration Date	:	04/03/2020
Last Update Date	:	04/03/2020

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