MEDICARE: DR. IVY HOPP SPEARS O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	27OA00435400	NJ
2	152WC0802X	Corneal and Contact Management Optometrist	27OA00435400	NJ
3	152WP0200X	Pediatric Optometrist	27OA00435400	NJ
4	152WS0006X	Sports Vision Optometrist	27OA00435400	NJ
5	152WV0400X	Vision Therapy Optometrist	27OA00435400	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0075755000	OTHER	NJ	AMERIHEALTH IND PROV ID
2	201330164	OTHER	NJ	QUALCARE GROUP ID NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	50596	OTHER	NJ	DAVIS VISION ID NUMBER
5	60016235	OTHER	NJ	HORIZON NJ HEALTH
6	310954	OTHER	NJ	NATIONAL VISION ADMIN ID
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	2K7427	OTHER	NJ	HEALTHNET IND ID NUMBER
9	01000500200	OTHER	NJ	AMERICHOICE
10	3628546	OTHER	NJ	AETNA (HMO)
11	P466316	OTHER	NJ	OXFORD IND ID NUMBER
12	30903	OTHER	NJ	GROUP VISION ASSOC ID NUM
13	G3410217	OTHER	NJ	OXFORD GROUP ID NUMBER
14	201330164	OTHER	NJ	HORIZON BC/BS ID NUMBER
15	2341813000	OTHER	NJ	AMERIHEALTH GROUP ID NUMB
16	3242884	OTHER	NJ	CIGNA IND ID NUMBER
17	4502254	OTHER	NJ	AETNA (NON-HMO)

General Provider Information

NPI Number	:	1093797912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IVY HOPP SPEARS O.D.

Provider Business Mailing Address
First Line	:	40 BEY LEA RD
Second Line	:	BEY LEA COMMONS SUITE C 104
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-2900
Country	:	US
Telephone Number	:	732-341-1070
Fax Number	:	732-341-1652

Provider Business Practice Location Address
First Line	:	40 BEY LEA RD
Second Line	:	BEY LEA COMMONS SUITE C 104
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-2900
Country	:	US
Telephone Number	:	732-341-1070
Fax Number	:	732-341-1652

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	03/04/2014

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