Provider Demographics
NPI:1740254762
Name:SPALDING, JOHN MATTHEW (OOD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MATTHEW
Last Name:SPALDING
Suffix:
Gender:M
Credentials:OOD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 MAJESTIC OAK DR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-2528
Mailing Address - Country:US
Mailing Address - Phone:407-886-1783
Mailing Address - Fax:
Practice Address - Street 1:5201 RAYMOND ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-8208
Practice Address - Country:US
Practice Address - Phone:407-629-1599
Practice Address - Fax:407-599-1340
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3177152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist