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NPI Code Detail

MEDICARE: JAMES SPEARS O.D.

MEDICARE: JAMES SPEARS O.D.
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
1152W00000XOptometrist4901002771MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750345674
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES SPEARS O.D.
Provider Business Mailing Address
First Line : 2860 E BELTLINE AVE NE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49525-9704
Country : US
Telephone Number : 616-364-8484
Fax Number : 616-364-9686
Provider Business Practice Location Address
First Line : 2860 E BELTLINE AVE NE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49525-9704
Country : US
Telephone Number : 616-364-8484
Fax Number : 616-364-9686
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2006
Last Update Date : 11/03/2010

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