Provider Demographics
NPI:1588770556
Name:SPEROS, PAUL A (OD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:SPEROS
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 1:6233 AGENBROAD RD
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-8760
Mailing Address - Country:US
Mailing Address - Phone:937-543-3930
Mailing Address - Fax:
Practice Address - Street 1:3360 NEW GERMANY TREBEIN RD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-1702
Practice Address - Country:US
Practice Address - Phone:937-426-4638
Practice Address - Fax:937-426-3627
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3834/T1279152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
T78409Medicare UPIN
SP0829171Medicare ID - Type Unspecified