Provider Demographics
NPI:1386780187
Name:SPITZER, LINDA JO (OD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:JO
Last Name:SPITZER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 CENTER AVE W
Mailing Address - Street 2:SINKLER OPTICAL SUITE C
Mailing Address - City:DILWORTH
Mailing Address - State:MN
Mailing Address - Zip Code:56529
Mailing Address - Country:US
Mailing Address - Phone:218-236-5048
Mailing Address - Fax:218-236-6217
Practice Address - Street 1:1675 CENTER AVE W
Practice Address - Street 2:SINKLER OPTICAL SUITE C
Practice Address - City:DILWORTH
Practice Address - State:MN
Practice Address - Zip Code:56529
Practice Address - Country:US
Practice Address - Phone:218-236-5048
Practice Address - Fax:218-236-6217
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND491152W00000X
MN0422152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6C493SPOtherBLUE CROSS
1014776OtherPREFERED ONE
ND70882OtherBLUE CROSS OF ND
2213418OtherMEDICA
HP24555OtherHEALTH PARTNERS
MN6C492SPOtherBLUE CROSS
U13614Medicare UPIN