Provider Demographics
NPI:1962611012
Name:JOHN C. SPAETH O.D.
Entity type:Organization
Organization Name:JOHN C. SPAETH O.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SPAETH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-692-2063
Mailing Address - Street 1:4945 YORBA RANCH RD
Mailing Address - Street 2:STE. E
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-2550
Mailing Address - Country:US
Mailing Address - Phone:714-692-2063
Mailing Address - Fax:
Practice Address - Street 1:4945 YORBA RANCH RD
Practice Address - Street 2:STE. E
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92887-2550
Practice Address - Country:US
Practice Address - Phone:714-692-2063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5602T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT70048Medicare UPIN