Active NPI
Gary C. Spencer, O.D.
- Optometrist
- Muskegon, MI
National Provider Identifier
1720154818
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 4901002683
- Practice address
- 3106 Glade St
Muskegon, MI 49444-2706 - Phone
- (231) 733-9669
- Fax
- (231) 733-9669
- NPI assigned
- Nov 28, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4901002683 | MI | Primary |
Addresses
Primary practice location
3106 Glade St
Muskegon, MI 49444-2706
Mailing address
2624 Oxford Cir
Ann Arbor, MI 48103-2447
Phone (734) 369-4833
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 450463757 | Other | MI | TAX ID # PRIORITY HEALTH |
| 71020000F16521 | Other | MI | BCBS |
| 900F165210 | Other | MI | BCBS |
| 900F165210 | Other | MI | BLUE CARE NETWORK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lakeshore Professional Eyecare PC | Optometrist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Optometrist
- Norton Shores, MI
- NPI 1629251400
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164672000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554249600000",
"number": "1720154818",
"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": "3106 GLADE ST",
"city": "MUSKEGON",
"state": "MI",
"postal_code": "494442706",
"telephone_number": "231-733-9669",
"fax_number": "231-733-9669"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPENCER",
"first_name": "GARY",
"middle_name": "C.",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-28",
"last_updated": "2019-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MI",
"license": "4901002683",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID # PRIORITY HEALTH",
"identifier": "450463757",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "71020000F16521",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "900F165210",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CARE NETWORK",
"identifier": "900F165210",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Muskegon, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.