Provider Demographics
NPI:1255954095
Name:SPETH, KAITLIN ANNA (OD)
Entity type:Individual
Prefix:DR
First Name:KAITLIN
Middle Name:ANNA
Last Name:SPETH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2935 FAIRFAX ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80207-2712
Mailing Address - Country:US
Mailing Address - Phone:720-708-8282
Mailing Address - Fax:
Practice Address - Street 1:3459 W 32ND AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-3103
Practice Address - Country:US
Practice Address - Phone:303-433-5820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003593152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty