Provider Demographics
NPI:1427756634
Name:SPENCER, CHERYL
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 E OHIO PIKE
Mailing Address - Street 2:
Mailing Address - City:AMELIA
Mailing Address - State:OH
Mailing Address - Zip Code:45102-2380
Mailing Address - Country:US
Mailing Address - Phone:513-797-1260
Mailing Address - Fax:513-797-1262
Practice Address - Street 1:1815 E OHIO PIKE
Practice Address - Street 2:
Practice Address - City:AMELIA
Practice Address - State:OH
Practice Address - Zip Code:45102-2380
Practice Address - Country:US
Practice Address - Phone:513-797-1260
Practice Address - Fax:513-797-1262
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-16
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician