MEDICARE: JAMES S SPANGLER, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	165920	OTHER	PA	HIGHMARK BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1912230350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES S SPANGLER, O.D.

Provider Business Mailing Address
First Line	:	213 W 3RD AVE
Second Line	:	SUITE 106
City	:	WARREN
State	:	PA
Zip	:	16365-2355
Country	:	US
Telephone Number	:	814-723-4470
Fax Number	:	814-723-5413

Provider Business Practice Location Address
First Line	:	213 W 3RD AVE
Second Line	:	SUITE 106
City	:	WARREN
State	:	PA
Zip	:	16365-2355
Country	:	US
Telephone Number	:	814-723-4470
Fax Number	:	814-723-5413

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JAMES STEVEN SPANGLER
Credential	:	O.D.
Telephone Number	:	814-723-4470

Provider Enumeration Date	:	09/17/2009
Last Update Date	:	09/17/2009

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