MEDICARE: SPENCER ONISHI D.O.

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	207W00000X	Ophthalmology Physician	OT016929	PA
2	207W00000X	Ophthalmology Physician	OS019879	PA

General Provider Information

NPI Number	:	1194119164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SPENCER ONISHI D.O.

Provider Business Mailing Address
First Line	:	100 N ACADEMY AVE
Second Line	:
City	:	DANVILLE
State	:	PA
Zip	:	17822-4903
Country	:	US
Telephone Number	:	570-271-6144
Fax Number	:	570-271-6578

Provider Business Practice Location Address
First Line	:	16 WOODBINE LANE
Second Line	:
City	:	DANVILLE
State	:	PA
Zip	:	17822-1334
Country	:	US
Telephone Number	:	570-271-6531
Fax Number	:	570-271-7146

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

Provider Enumeration Date	:	03/26/2015
Last Update Date	:	02/11/2021

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Directions to “ SPENCER ONISHI D.O.” Practice Location

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