NPIMap

Organization Active NPI

Gary C. Spencer O.D., P.C.

  • Optometrist
  • Ann Arbor, MI
National Provider Identifier
1124194295
Registry record updated Oct 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4901002683 Issued in MI
Legal business name
GARY C. SPENCER O.D., P.C.
Practice address
2624 Oxford Cir
Ann Arbor, MI 48103-2447
Phone
(734) 369-4833
NPI assigned
Nov 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gary C. Spencer, OD
Title
President
Phone
(734) 369-4833

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 4901002683 MI Primary

Addresses

Primary practice location

2624 Oxford Cir
Ann Arbor, MI 48103-2447

Mailing address

2624 Oxford Cir
Ann Arbor, MI 48103-2447
Phone (734) 369-4833

Other identifiers 3

IdentifierTypeStateIssuer
900F165210OtherMIBLUE CARE NETWORK
0F11250OtherMIBCBS
71020000F16521OtherMIBCBS

Other names 1

  • Optometry West Doing business as

National Provider Directory

National Provider Directory

Locations

3106 Glade St
Muskegon, MI 49444
Phone (231) 733-9669

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538611200000",
    "number": "1124194295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2624 OXFORD CIR",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481032447",
            "telephone_number": "734-369-4833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2624 OXFORD CIR",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481032447",
            "telephone_number": "734-369-4833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARY C. SPENCER O.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2018-10-04",
        "status": "A",
        "authorized_official_last_name": "SPENCER",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "734-369-4833",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901002683",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE NETWORK",
            "identifier": "900F165210",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0F11250",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "71020000F16521",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optometry West",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Optometry West",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ann Arbor, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.