David Keith Spencer, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046007635 Issued in IL

Practice address

711 N Main St
Benton, IL 62812-1017

Phone

(618) 439-7256

Fax

(618) 439-7257

NPI assigned

Aug 2, 2006

Last updated

Apr 25, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• David K. Spencer, O.D.

  • Optometrist
  • Benton, IL
  • NPI 1316121015
  Authorized official Same address or phone
• Spencer Family Eye Care, LLC

  • Optometrist
  • McLeansboro, IL
  • NPI 1225605637
  NPD
• Spencer Family Eye Care, LLC

  • Optometrist
  • Benton, IL
  • NPI 1639754328
  NPD

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209081600000",
    "number": "1750398467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 N MAIN ST",
            "city": "BENTON",
            "state": "IL",
            "postal_code": "628121017",
            "telephone_number": "618-439-7256",
            "fax_number": "618-439-7257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 N MAIN ST",
            "city": "BENTON",
            "state": "IL",
            "postal_code": "628121017",
            "telephone_number": "618-439-7256",
            "fax_number": "618-439-7257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPENCER",
        "first_name": "DAVID",
        "middle_name": "KEITH",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2008-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046007635",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046007635",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southern Illinois Medical Services, NFP (Benton Community Healthcare)
• Southern Illinois Medical Services, NFP (Benton Community Healthcare)
• Southern Illinois Sport and Spine LLC
• Southern Illinois Therapy Services, PLLC
• Spencer Family Eye Care, LLC
• Michael Sebastian Spencer, O.D.
• Chelsea Steele
• Hannah Stock
• Stonebridge Nursing & Rehabilitation Center, LLC
• Stonebridge Senior Living Center, LLC

• Optometrist in Benton, IL
• Providers in Benton, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2008; 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.