Provider Demographics
NPI:1912960022
Name:SPENCER, MICHAEL F (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:F
Last Name:SPENCER
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 1:4101 EVANS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901
Mailing Address - Country:US
Mailing Address - Phone:239-335-1944
Mailing Address - Fax:239-939-1575
Practice Address - Street 1:3507 LEE BLVD STE 104
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1303
Practice Address - Country:US
Practice Address - Phone:239-369-5884
Practice Address - Fax:239-369-7320
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3452152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2139708OtherCIGNA
FL620823100Medicaid
FL20759OtherBLUE CROSS BLUE SHIELD
FL7037476OtherAETNA
FL7037476OtherAETNA
FL7037476OtherAETNA