Provider Demographics
NPI:1861494304
Name:SPENCER, PATRICK L (DO)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:L
Last Name:SPENCER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:425 W GRAND AVE
Mailing Address - Street 2:STE 1002
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-4775
Mailing Address - Country:US
Mailing Address - Phone:937-226-7870
Mailing Address - Fax:937-226-7829
Practice Address - Street 1:425 W GRAND AVE
Practice Address - Street 2:STE 1002
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-4775
Practice Address - Country:US
Practice Address - Phone:937-298-5536
Practice Address - Fax:937-298-5596
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-6232-S207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2050739Medicaid
OHP00082409Medicare PIN
OH2050739Medicaid
OH0843982Medicare PIN