Provider Demographics
NPI:1780859306
Name:SPENCER EYE CARE LTD
Entity Type:Organization
Organization Name:SPENCER EYE CARE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:773-237-4774
Mailing Address - Street 1:4949 W IRVING PARK RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-2655
Mailing Address - Country:US
Mailing Address - Phone:773-237-4774
Mailing Address - Fax:773-202-9909
Practice Address - Street 1:4949 W IRVING PARK RD
Practice Address - Street 2:SUITE E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-2655
Practice Address - Country:US
Practice Address - Phone:773-237-4774
Practice Address - Fax:773-202-9909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.008177152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046008177Medicaid
IL046008177Medicaid