Provider Demographics
NPI:1164502530
Name:SPITLER, ANTHONY D (OD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:D
Last Name:SPITLER
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 1:12316 FRANK DR
Mailing Address - Street 2:
Mailing Address - City:BRUCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48065-4486
Mailing Address - Country:US
Mailing Address - Phone:586-883-5088
Mailing Address - Fax:
Practice Address - Street 1:26768 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-3939
Practice Address - Country:US
Practice Address - Phone:586-751-3700
Practice Address - Fax:586-751-5398
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003673152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900E066320OtherBLUE CROSS & BLUE SHIELD
MI0M59020Medicare ID - Type Unspecified
MIU49166Medicare UPIN