Provider Demographics
NPI:1659429116
Name:SPETH, JAMIE L (OD)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:L
Last Name:SPETH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JAMIE
Other - Middle Name:L
Other - Last Name:KILLS CROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:9300 E 29TH ST N STE 315
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2184
Mailing Address - Country:US
Mailing Address - Phone:316-425-0445
Mailing Address - Fax:316-425-0460
Practice Address - Street 1:9300 E 29TH ST N STE 315
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2184
Practice Address - Country:US
Practice Address - Phone:316-425-0445
Practice Address - Fax:316-425-0460
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2442152W00000X
KS1833152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS2006786860AMedicaid
KS200573120AMedicaid
CO803158Medicare ID - Type Unspecified