Provider Demographics
NPI:1003832270
Name:SPECTERA
Entity Type:Organization
Organization Name:SPECTERA
Other - Org Name:UNITED OPTICAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE PRESIDENT DIRECTOR OF OPTICAL
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:HEETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-316-2061
Mailing Address - Street 1:2811 LORD BALTIMORE DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244
Mailing Address - Country:US
Mailing Address - Phone:443-316-2101
Mailing Address - Fax:410-265-6068
Practice Address - Street 1:1005 EAST GREEN STREET
Practice Address - Street 2:UNITED OPTICAL
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106
Practice Address - Country:US
Practice Address - Phone:626-683-7471
Practice Address - Fax:626-577-1527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier