Provider Demographics
NPI:1033102694
Name:SPAETH, FRANK WILLIAM (OD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:WILLIAM
Last Name:SPAETH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 BURLINGTON ROAD
Mailing Address - Street 2:
Mailing Address - City:WHITSETT
Mailing Address - State:NC
Mailing Address - Zip Code:27377-9748
Mailing Address - Country:US
Mailing Address - Phone:336-449-1333
Mailing Address - Fax:336-449-1348
Practice Address - Street 1:6611 BURLINGTON RD
Practice Address - Street 2:
Practice Address - City:WHITSETT
Practice Address - State:NC
Practice Address - Zip Code:27377-9748
Practice Address - Country:US
Practice Address - Phone:336-449-1333
Practice Address - Fax:336-449-1348
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2010-05-20
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
NC0895152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0929XOtherBCBS
NC89093PKMedicaid
NCT64796Medicare UPIN
NC246246GMedicare PIN