Organization
DAVID K. SPENCER, O.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID KEITH SPENCER O. D. (OWNER)
(618) 439-7256
Entity
Organization
Contact information
Practice address
711 N MAIN ST, BENTON, IL 62812-1017
(618) 439-7256
(618) 439-7257
Mailing address
711 N MAIN ST, BENTON, IL 62812-1017
(618) 439-7256
(618) 439-7257
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046007635
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046007635
—
IL
Enumeration date
12/18/2007
Last updated
05/27/2008
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