Provider Demographics
NPI:1114651817
Name:SPICHER, SYDNI GRACE (OD)
Entity Type:Individual
Prefix:
First Name:SYDNI
Middle Name:GRACE
Last Name:SPICHER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 HUNT CLUB DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-8385
Mailing Address - Country:US
Mailing Address - Phone:515-509-6449
Mailing Address - Fax:
Practice Address - Street 1:393 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3532
Practice Address - Country:US
Practice Address - Phone:718-964-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2023-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003932152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist