Provider Demographics
NPI:1063420768
Name:BRITTAIN, SPENSER J (OD)
Entity type:Individual
Prefix:DR
First Name:SPENSER
Middle Name:J
Last Name:BRITTAIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6812 LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPERANCE
Mailing Address - State:MI
Mailing Address - Zip Code:48182-1203
Mailing Address - Country:US
Mailing Address - Phone:734-693-4443
Mailing Address - Fax:
Practice Address - Street 1:6812 LEWIS AVE
Practice Address - Street 2:
Practice Address - City:TEMPERANCE
Practice Address - State:MI
Practice Address - Zip Code:48182-1203
Practice Address - Country:US
Practice Address - Phone:734-693-4443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004368152W00000X
PAOEG001499152W00000X
OH5673152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4918263Medicaid
MI4918263Medicaid
P00377657Medicare PIN