Provider Demographics
NPI:1235214628
Name:SPEAKMAN, PAUL A (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:SPEAKMAN
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 1:1261 BARING BLVD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-8673
Mailing Address - Country:US
Mailing Address - Phone:775-353-5665
Mailing Address - Fax:775-353-5660
Practice Address - Street 1:1261 BARING BLVD
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-8673
Practice Address - Country:US
Practice Address - Phone:775-353-5665
Practice Address - Fax:775-353-5660
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV169152W00000X
OH3378152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0296970001Medicare NSC
31760Medicare PIN
T67371Medicare UPIN