Organization
KOALA EYE CENTRE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL ANTONIO SPENCER M.D. (PRESIDENT/ OWNER)
(336) 378-2511
Entity
Organization
Contact information
Practice address
719 GREEN VALLEY RD, STE. 303, GREENSBORO, NC 27408-7014
(336) 378-2511
(336) 378-1186
Mailing address
719 GREEN VALLEY RD, STE. 303, GREENSBORO, NC 27408-7014
(336) 378-2511
(336) 378-1186
Taxonomy
Speciality
Code
Description
License number
State
261QS0132X
Ophthalmologic Surgery Clinic/Center
Primary
200100470
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8913132
—
NC
Enumeration date
10/29/2007
Last updated
04/14/2008
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