Provider Demographics
NPI:1801179270
Name:SPENSER J. BRITTAIN, O.D. PLLC
Entity Type:Organization
Organization Name:SPENSER J. BRITTAIN, O.D. PLLC
Other - Org Name:PREMIER VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SPENSER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BRITTAIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:734-693-4443
Mailing Address - Street 1:6812 LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPERANCE
Mailing Address - State:MI
Mailing Address - Zip Code:48182-1203
Mailing Address - Country:US
Mailing Address - Phone:734-224-7020
Mailing Address - Fax:734-224-7022
Practice Address - Street 1:6878 PINE CREEK CT
Practice Address - Street 2:
Practice Address - City:TEMPERANCE
Practice Address - State:MI
Practice Address - Zip Code:48182-1596
Practice Address - Country:US
Practice Address - Phone:734-224-0039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004368152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty