Provider Demographics
NPI: | 1740206879 |
---|---|
Name: | SPECTERA |
Entity Type: | Organization |
Organization Name: | SPECTERA |
Other - Org Name: | UNITED OPTICAL |
Other - Org Type: | Former Legal Business Name |
Authorized Official - Title/Position: | VICE PRESIDENT DIRECTOR OF OPTICAL |
Authorized Official - Prefix: | |
Authorized Official - First Name: | THOMAS |
Authorized Official - Middle Name: | A |
Authorized Official - Last Name: | HETTER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 443-316-2061 |
Mailing Address - Street 1: | 2811 LORD BALTIMORE DR |
Mailing Address - Street 2: | |
Mailing Address - City: | BALTIMORE |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 21244 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 443-316-2101 |
Mailing Address - Fax: | 410-265-6068 |
Practice Address - Street 1: | 925 NATIONAL HIGHWAY |
Practice Address - Street 2: | |
Practice Address - City: | CUMBERLAND LOVALE |
Practice Address - State: | MD |
Practice Address - Zip Code: | 21502 |
Practice Address - Country: | US |
Practice Address - Phone: | 301-729-2243 |
Practice Address - Fax: | 301-729-1559 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-07-14 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 332H00000X | Suppliers | Eyewear Supplier |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
========= | Other | EIN |