Provider Demographics
NPI:1124282637
Name:SPANDA INC
Entity type:Organization
Organization Name:SPANDA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DE ANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:319-366-3500
Mailing Address - Street 1:3235 WILLIAMS PARKWAY SW STE 1
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-1427
Mailing Address - Country:US
Mailing Address - Phone:319-364-2311
Mailing Address - Fax:319-366-3513
Practice Address - Street 1:3235 WILLIAMS PARKWAY SW STE 1
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-1427
Practice Address - Country:US
Practice Address - Phone:319-364-2311
Practice Address - Fax:319-366-3513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty