1386780187 NPI number — DR. LINDA JO SPITZER OD

Table of content: DR. LINDA JO SPITZER OD (NPI 1386780187)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386780187 NPI number — DR. LINDA JO SPITZER OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPITZER
Provider First Name:
LINDA
Provider Middle Name:
JO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386780187
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1675 CENTER AVE W
Provider Second Line Business Mailing Address:
SINKLER OPTICAL SUITE C
Provider Business Mailing Address City Name:
DILWORTH
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56529
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-236-5048
Provider Business Mailing Address Fax Number:
218-236-6217

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1675 CENTER AVE W
Provider Second Line Business Practice Location Address:
SINKLER OPTICAL SUITE C
Provider Business Practice Location Address City Name:
DILWORTH
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-236-5048
Provider Business Practice Location Address Fax Number:
218-236-6217
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  491 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 0422 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6C493SP . This is a "BLUE CROSS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1014776 . This is a "PREFERED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 70882 . This is a "BLUE CROSS OF ND" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 2213418 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: HP24555 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6C492SP . This is a "BLUE CROSS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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