Provider Demographics
NPI:1508835919
Name:SPAETH, JOHN C JR (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:SPAETH
Suffix:JR
Gender:M
Credentials:OD
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Mailing Address - Street 1:32585 GOLDEN LANTERN STREET H
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629
Mailing Address - Country:US
Mailing Address - Phone:949-493-1600
Mailing Address - Fax:949-493-4626
Practice Address - Street 1:32585 GOLDEN LANTERN STREET # H
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629
Practice Address - Country:US
Practice Address - Phone:949-493-1600
Practice Address - Fax:949-493-4626
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA10236T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist