Provider Demographics
NPI:1295960466
Name:SPARE PAIR OPTICAL
Entity type:Organization
Organization Name:SPARE PAIR OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMITRIST/OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JOINES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:830-624-9099
Mailing Address - Street 1:1305 EAST COMMON STREET SUITE 204
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130
Mailing Address - Country:US
Mailing Address - Phone:830-624-9099
Mailing Address - Fax:830-629-5869
Practice Address - Street 1:1308 E COMMON ST
Practice Address - Street 2:SUITE 204
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3557
Practice Address - Country:US
Practice Address - Phone:830-624-9099
Practice Address - Fax:830-629-5869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX080003511332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies