Provider Demographics
NPI:1669586541
Name:SPANFELNER, MICHAEL DAVID (OD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:SPANFELNER
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 1:1550 MYERS ST
Mailing Address - Street 2:STE A
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965-4689
Mailing Address - Country:US
Mailing Address - Phone:530-533-6604
Mailing Address - Fax:530-533-6568
Practice Address - Street 1:1550 MYERS ST
Practice Address - Street 2:STE A
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965-4689
Practice Address - Country:US
Practice Address - Phone:530-533-6604
Practice Address - Fax:530-533-6568
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10240T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00479427OtherMEDICARE RAILROAD CARRIER
CAZZZ55000YOtherBLUE SHIELD OF CALIFORNIA
CAGSD001930Medicaid
CAGSD001930Medicaid
CAZZZ07042ZMedicare PIN
U46405Medicare UPIN
CASD0102400Medicare PIN