Provider Demographics
NPI:1649338021
Name:SPEARS, GEOFFREY ALAN (OD)
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:ALAN
Last Name:SPEARS
Suffix:
Gender:M
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:PO BOX 1419
Mailing Address - Street 2:
Mailing Address - City:MURPHYSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62966-1419
Mailing Address - Country:US
Mailing Address - Phone:618-687-2922
Mailing Address - Fax:618-684-4580
Practice Address - Street 1:1008 LOCUST ST
Practice Address - Street 2:
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966-2155
Practice Address - Country:US
Practice Address - Phone:618-687-2922
Practice Address - Fax:618-684-4580
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.007873152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL371217631OtherFEDERAL TAX ID
IL371217631OtherFEDERAL TAX ID