Healthcare Provider Details

I. General information

NPI: 1912960022
Provider Name (Legal Business Name): MICHAEL F SPENCER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3507 LEE BLVD STE 104
LEHIGH ACRES FL
33971-1303
US

IV. Provider business mailing address

PO BOX 162264
ALTAMONTE SPRINGS FL
32716-2264
US

V. Phone/Fax

Practice location:
  • Phone: 239-369-5884
  • Fax: 239-369-7320
Mailing address:
  • Phone: 941-792-2020
  • Fax: 239-939-1575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC3452
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: