Provider Demographics
NPI:1598831950
Name:DR. FRANK W. SPAETH
Entity Type:Organization
Organization Name:DR. FRANK W. SPAETH
Other - Org Name:BRIGHTWOOD EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SPAETH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:336-449-1333
Mailing Address - Street 1:6611 BURLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:WHITSETT
Mailing Address - State:NC
Mailing Address - Zip Code:27377-9748
Mailing Address - Country:US
Mailing Address - Phone:336-449-1333
Mailing Address - Fax:336-449-1348
Practice Address - Street 1:6611 BURLINGTON RD
Practice Address - Street 2:
Practice Address - City:WHITSETT
Practice Address - State:NC
Practice Address - Zip Code:27377-9748
Practice Address - Country:US
Practice Address - Phone:336-449-1333
Practice Address - Fax:336-449-1348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0895152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC019HNOtherBCBS
NC5950490Medicaid
NCT64796Medicare UPIN
NC1274Medicare ID - Type Unspecified
NC0335650001Medicare NSC