Provider Demographics
NPI:1699173104
Name:SPALDING, ALYSSA (OD)
Entity type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:
Last Name:SPALDING
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 1:3536 MORNING DEW CV
Mailing Address - Street 2:
Mailing Address - City:APISON
Mailing Address - State:TN
Mailing Address - Zip Code:37302-2500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5588 LITTLE DEBBIE PKWY
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-4356
Practice Address - Country:US
Practice Address - Phone:423-490-9173
Practice Address - Fax:423-760-3061
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-15
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3215152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist