Provider Demographics
NPI:1851758346
Name:SPECTERA, INC.
Entity Type:Organization
Organization Name:SPECTERA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY GENERAL COUNSEL MGR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS-DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-896-0623
Mailing Address - Street 1:6220 OLD DOBBIN LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5812
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2111 VAN DEMAN ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-6609
Practice Address - Country:US
Practice Address - Phone:410-631-2840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier