Provider Demographics
NPI:1790850022
Name:SPEEL, DAVID EMERSON (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EMERSON
Last Name:SPEEL
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 1:6000 ROUTE 378
Mailing Address - Street 2:
Mailing Address - City:CENTER VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18034-9498
Mailing Address - Country:US
Mailing Address - Phone:610-282-3969
Mailing Address - Fax:610-282-3128
Practice Address - Street 1:6000 ROUTE 378
Practice Address - Street 2:
Practice Address - City:CENTER VALLEY
Practice Address - State:PA
Practice Address - Zip Code:18034-9498
Practice Address - Country:US
Practice Address - Phone:610-282-3969
Practice Address - Fax:610-282-3128
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOET-008976152WC0802X
PAOEG001974152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA441580685OtherMEDICARE RAILROAD
PAT29430Medicare UPIN
PA441580685OtherMEDICARE RAILROAD
PA0605210001Medicare NSC