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General NPI Number Information
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NPI Number | 1073573788
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Entity Type | Individual
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Provider Name | TIMOTHY GLENN SPENCE O.D.
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Gender | Male
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Dates
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Enumeration Date | 03/25/2006
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Last Update Date | 09/25/2008
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Provider Practice Location Address
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Address Line | 9550 JONES BRIDGE RD SUITE 200
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City | ALPHARETTA
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State | GA
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Zip | 30022
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Country | US
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Telephone | 770-475-1242
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Fax | 770-475-1032
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Provider Business Mailing Address
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Address Line | 4330 JOHNS CREEK PKWY SUITE 300
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City | SUWANEE
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State | GA
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Zip | 30024-6120
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Country | US
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Telephone | 770-232-7844
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Fax | 770-232-9455
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT001255
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License Number State | GA
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