Provider Demographics
NPI:1467506907
Name:SPENCER EYE SURGERY & LASER CENTER, INC.
Entity Type:Organization
Organization Name:SPENCER EYE SURGERY & LASER CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-983-0923
Mailing Address - Street 1:1200 W GONZALES RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-3072
Mailing Address - Country:US
Mailing Address - Phone:805-983-0923
Mailing Address - Fax:805-983-0976
Practice Address - Street 1:2486 N PONDEROSA DR
Practice Address - Street 2:SUITE D110
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2376
Practice Address - Country:US
Practice Address - Phone:805-983-0923
Practice Address - Fax:805-484-5857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAS551002261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS551002Medicare ID - Type Unspecified