Provider Demographics
NPI:1073130035
Name:SPADAFORA EYE CARE PLLC
Entity Type:Organization
Organization Name:SPADAFORA EYE CARE PLLC
Other - Org Name:ANN MARIE SPADAFORA, OD
Other - Org Type:Other Name
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPADAFORA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:248-709-5099
Mailing Address - Street 1:8111 ROSEBUD LANE
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348
Mailing Address - Country:US
Mailing Address - Phone:248-709-5099
Mailing Address - Fax:
Practice Address - Street 1:6445 CITATION DR STE B
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2996
Practice Address - Country:US
Practice Address - Phone:248-709-5099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-25
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty