MEDICARE: DR. KATIE GILBERT SPEAR OD

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	152W00000X	Optometrist	OPC3920	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	68122	OTHER	FL	BCBS OF FL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548253974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATIE GILBERT SPEAR OD

Provider Business Mailing Address
First Line	:	36 EGLIN PKWY NE
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32548-4915
Country	:	US
Telephone Number	:	850-243-3111
Fax Number	:	850-200-4373

Provider Business Practice Location Address
First Line	:	770 US HIGHWAY 331 S
Second Line	:	STE 1
City	:	DEFUNIAK SPRINGS
State	:	FL
Zip	:	32435-3307
Country	:	US
Telephone Number	:	850-207-2080
Fax Number	:

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

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	07/05/2022

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