Provider Demographics
NPI:1104486489
Name:SPENCER, CAROLINE R (OD)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:R
Last Name:SPENCER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:CAROLINE
Other - Middle Name:
Other - Last Name:SEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4000 POPLAR LEVEL RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-1524
Mailing Address - Country:US
Mailing Address - Phone:502-813-8928
Mailing Address - Fax:502-456-9121
Practice Address - Street 1:1303 SUITE 108 US HWY. 127 S.
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4424
Practice Address - Country:US
Practice Address - Phone:502-875-3050
Practice Address - Fax:502-226-4261
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004159A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2154DTOtherKENTUCKY LICENSE
IN18004159AOtherINDIANA LICENSE