Healthcare Provider Details

I. General information

NPI: 1609700939
Provider Name (Legal Business Name): SPENCER PRITCHARD OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6020 E 82ND ST
INDIANAPOLIS IN
46250-4746
US

IV. Provider business mailing address

151 COTTON RIDGE CV S
CORDOVA TN
38018-7409
US

V. Phone/Fax

Practice location:
  • Phone: 317-841-0825
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18004667A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: