Provider Demographics
NPI:1144473802
Name:SPENCER, ALEXIS DANIELLE (OD)
Entity type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:DANIELLE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ALEXIS
Other - Middle Name:DANIELLE
Other - Last Name:CHARLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2622 SERENITY LN
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-0646
Mailing Address - Country:US
Mailing Address - Phone:703-342-8889
Mailing Address - Fax:
Practice Address - Street 1:596 BOBBY JONES EXPY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-5300
Practice Address - Country:US
Practice Address - Phone:703-342-8889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001742152W00000X
GAOPT002562152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist