Provider Demographics
NPI:1194749911
Name:SPANGLER, JAMES STEVEN (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:STEVEN
Last Name:SPANGLER
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 1:213 W 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-2355
Mailing Address - Country:US
Mailing Address - Phone:814-723-4470
Mailing Address - Fax:814-723-4470
Practice Address - Street 1:213 W 3RD AVE
Practice Address - Street 2:STE. 106
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-2355
Practice Address - Country:US
Practice Address - Phone:814-723-4470
Practice Address - Fax:814-723-4470
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG-000680152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000769281Medicaid
410039073OtherRR MEDICARE
PA000769281Medicaid
1058060001Medicare NSC
T29849Medicare UPIN
SP165920Medicare PIN