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General NPI Number Information
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NPI Number | 1144530833
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Entity Type | Organization
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Legal Business Name | SPENCER EYE CARE, LLC
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Dates
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Enumeration Date | 10/14/2010
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Last Update Date | 10/14/2010
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Provider Practice Location Address
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Address Line | 596 BOBBY JONES EXPY
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City | AUGUSTA
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State | GA
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Zip | 30907-5300
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Country | US
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Telephone | 706-863-1150
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Fax |
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Provider Business Mailing Address
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Address Line | 2622 SERENITY LN
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City | AUGUSTA
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State | GA
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Zip | 30909-0646
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Country | US
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Telephone | 703-342-8889
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. ALEXIS DANIELLE SPENCER
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Credential | O.D.
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Telephone | 703-342-8889
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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 | 2562
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License Number State | GA
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