Provider Demographics
NPI:1801949573
Name:SPECTRUM EYECARE OPTOMETRY INC
Entity type:Organization
Organization Name:SPECTRUM EYECARE OPTOMETRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:SWEARINGEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:909-394-0462
Mailing Address - Street 1:425 W BONITA AVE
Mailing Address - Street 2:SUITE 110B
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-2541
Mailing Address - Country:US
Mailing Address - Phone:909-394-0462
Mailing Address - Fax:
Practice Address - Street 1:425 W BONITA AVE
Practice Address - Street 2:SUITE 110B
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2541
Practice Address - Country:US
Practice Address - Phone:909-394-0462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11528T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5892280001OtherPTAN
CAW20601OtherMEDICARE GROUP NUMBER
CADF7961OtherRAILROAD GROUP NUMBER
CAP00393465OtherRAILROAD PTAN
CA5892280001Medicare NSC
CAW20601OtherMEDICARE GROUP NUMBER