Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 573 | SC |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 573 | SC |
NPI | 1174677280 |
---|---|
Provider Name | Dr. Thomas L Spitz |
First Address | Charleston, SC 29417-1919 |
Second Address | Charleston, SC 29407-7859 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DO5732 | (05) | SC |