MEDICARE: SPECTERA

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	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1588680763
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECTERA

Provider Business Mailing Address
First Line	:	2811 LORD BALTIMORE DR
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21244-2613
Country	:	US
Telephone Number	:	443-316-2101
Fax Number	:	410-265-6068

Provider Business Practice Location Address
First Line	:	816 CAMARILLO SPRINGS RD
Second Line	:	UNITED OPTICAL
City	:	CAMARILLO
State	:	CA
Zip	:	93012-9441
Country	:	US
Telephone Number	:	805-383-6622
Fax Number	:	805-383-6572

Authorized Official
Title or Position	:	VICE PRESIDENT DIRECTOR OF OPTICAL
Name	:	THOMAS A HEETER
Credential	:
Telephone Number	:	443-316-2061

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	08/22/2020

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Directions to “SPECTERA ” Practice Location

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