Provider Demographics
NPI:1083800452
Name:SPENCER QUINTON OD INC
Entity Type:Organization
Organization Name:SPENCER QUINTON OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-983-0320
Mailing Address - Street 1:305 N PECOS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-1351
Mailing Address - Country:US
Mailing Address - Phone:702-983-0320
Mailing Address - Fax:702-737-0321
Practice Address - Street 1:305 N PECOS RD
Practice Address - Street 2:SUITE A
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-1351
Practice Address - Country:US
Practice Address - Phone:702-983-0320
Practice Address - Fax:702-737-0321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV33801Medicare PIN
NVU77536Medicare UPIN