Individual
DR. GARY C. SPENCER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3106 GLADE ST, MUSKEGON, MI 49444-2706
(231) 733-9669
(231) 733-9669
Mailing address
2624 OXFORD CIR, ANN ARBOR, MI 48103-2447
(734) 369-4833
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901002683
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
450463757
TAX ID # PRIORITY HEALTH
MI
01
—
71020000F16521
BCBS
MI
01
—
900F165210
BCBS
MI
Enumeration date
11/28/2006
Last updated
04/03/2019
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