Individual
MICHAEL ANTONIO SPENCER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
719 GREEN VALLEY RD, KOALA EYE CENTRE STE 303, GREENSBORO, NC 27408-7014
(336) 378-2511
(336) 378-1186
Mailing address
719 GREEN VALLEY RD, KOALA EYE CENTRE STE 303, GREENSBORO, NC 27408-7014
(336) 378-2511
(336) 378-1186
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
200100470
NC
207WX0110X
Pediatric Ophthalmology and Strabismus Specialist Physician
200100470
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010678177
TAX I.D.
NC
05
—
8913132
—
NC
Enumeration date
04/27/2006
Last updated
01/24/2019
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