MEDICARE: JASON THOMAS SPAUDE 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	4901005697	MI

General Provider Information

NPI Number	:	1831889930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON THOMAS SPAUDE OD

Provider Business Mailing Address
First Line	:	2603 NILES AVE STE A
Second Line	:
City	:	SAINT JOSEPH
State	:	MI
Zip	:	49085-1954
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2603 NILES AVE STE A
Second Line	:
City	:	SAINT JOSEPH
State	:	MI
Zip	:	49085-1954
Country	:	US
Telephone Number	:	269-408-8762
Fax Number	:	269-408-8764

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

Provider Enumeration Date	:	05/11/2023
Last Update Date	:	10/25/2023

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