Provider Demographics
NPI:1265126080
Name:SPOORS, JEANINE (OD)
Entity type:Individual
Prefix:
First Name:JEANINE
Middle Name:
Last Name:SPOORS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6677 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-6386
Mailing Address - Country:US
Mailing Address - Phone:850-485-5764
Mailing Address - Fax:
Practice Address - Street 1:6677 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-6386
Practice Address - Country:US
Practice Address - Phone:850-485-5764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2317DT152W00000X
FLOPC6353152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist