Provider Demographics
NPI:1467664151
Name:SPAULDING, DONALD HUNTLEY (OD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:HUNTLEY
Last Name:SPAULDING
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 1:944 W FOOTHILL BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3757
Mailing Address - Country:US
Mailing Address - Phone:909-982-3040
Mailing Address - Fax:909-982-5996
Practice Address - Street 1:944 W FOOTHILL BLVD STE A
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3757
Practice Address - Country:US
Practice Address - Phone:909-982-3040
Practice Address - Fax:909-982-5996
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6810-T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD 0068100Medicaid
CASD0068100OtherMEDICARE RENDERING #
CASD0068101OtherMEDICARE PTAN
CASD 0068100Medicaid