MEDICARE: DR. JUDITH UPTEGRAFF SPAETH 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
1	152W00000X	Optometrist	0896	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	09853	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821139965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDITH UPTEGRAFF SPAETH O.D.

Provider Business Mailing Address
First Line	:	6611 BURLINGTON RD
Second Line	:
City	:	WHITSETT
State	:	NC
Zip	:	27377-9748
Country	:	US
Telephone Number	:	336-449-1333
Fax Number	:	336-449-1348

Provider Business Practice Location Address
First Line	:	6611 BURLINGTON RD
Second Line	:
City	:	WHITSETT
State	:	NC
Zip	:	27377-9748
Country	:	US
Telephone Number	:	336-449-1333
Fax Number	:	336-449-1348

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

Provider Enumeration Date	:	02/10/2007
Last Update Date	:	10/22/2010

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