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Michael Antonio Spencer

Ophthalmology

Allopathic & Osteopathic Physicians

719 Green Valley Rd, Koala Eye Centre Ste 303, Greensboro, NC 27408-7014

PECOS Enrollment

This provider is enrolled in PECOS as MICHAEL SPENCER.

Based on the most recent information from CMS, provider Michael Antonio Spencer is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records today at 10:51 AM.

Profile Details

Provider ID
1922065689
Provider Type
Individual
Full Name
Spencer, Michael Antonio
Credential
M.D.

Gender
Male
Sole Proprietor
No
Enumeration Date
4/27/2006
Last Updated
1/24/2019

Contact Information

Practice Location

719 Green Valley Rd, Koala Eye Centre Ste 303, Greensboro, NC 27408-7014

(336) 378-2511

(336) 378-1186

Mailing Location

719 Green Valley Rd, Koala Eye Centre Ste 303, Greensboro, NC 27408-7014

(336) 378-2511

(336) 378-1186

Provider Taxonomies

Code	Description	License
Code 207W00000X Primary	Description Ophthalmology Allopathic & Osteopathic Physicians	License 200100470 North Carolina
Code 207WX0110X	Description Ophthalmology Allopathic & Osteopathic Physicians	License 200100470 North Carolina

Provider Identifiers

ID	Description	Issuer
ID 8913132	Description Medicaid	Issuer Unlisted North Carolina
ID 010678177	Description Other	Issuer TAX I.D. North Carolina

Michael Antonio Spencer

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

Hecker Ophthalmology Pa

Sethi, Shashi Kumar

Cashwell, Leon Franklin

Patel, Martha Grace Green

Pediatric Opthalmology Assoc Pa

Hecker, Kathryn J

Stoneburner, Sara Ellen

Bowen, Bradley Edward

Pediatric Ophthalmology Associates, P.A.

Tanner, Michael C.