Provider Demographics
NPI:1235387671
Name:SPEARS, LEA KAY (OD)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:KAY
Last Name:SPEARS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LEA
Other - Middle Name:KAY
Other - Last Name:MCCORMICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:207 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-3543
Mailing Address - Country:US
Mailing Address - Phone:850-683-0221
Mailing Address - Fax:850-683-0225
Practice Address - Street 1:207 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-3543
Practice Address - Country:US
Practice Address - Phone:850-683-0221
Practice Address - Fax:850-683-0225
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4350152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000859600Medicaid
FL02237OtherBLUE CROSS AND BLUE SHIELD OF FLORIDA
FL000859600Medicaid