Provider Demographics
NPI:1699811877
Name:SPOONER, MICHELE L (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:L
Last Name:SPOONER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:821 HUNTINGDON PIKE
Mailing Address - Street 2:STE 200
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-8372
Mailing Address - Country:US
Mailing Address - Phone:215-884-8419
Mailing Address - Fax:215-884-8127
Practice Address - Street 1:510 WEST AVE
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2725
Practice Address - Country:US
Practice Address - Phone:215-884-8419
Practice Address - Fax:215-884-8127
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001687152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist