Provider Demographics
NPI:1487645180
Name:SPIRO, DENNIS JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:JAMES
Last Name:SPIRO
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 1:11311 LA MIRADA BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90604-2126
Mailing Address - Country:US
Mailing Address - Phone:562-946-3311
Mailing Address - Fax:562-941-3117
Practice Address - Street 1:11311 LA MIRADA BLVD
Practice Address - Street 2:STE B
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90604-2126
Practice Address - Country:US
Practice Address - Phone:562-946-3311
Practice Address - Fax:562-941-3117
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT8863T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD001460Medicaid
CAGSD001460Medicaid
CA5123060001Medicare NSC
CAOP8863Medicare PIN
CAP01015101Medicare PIN