Provider Demographics
NPI:1548253974
Name:SPEAR, KATIE GILBERT (OD)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:GILBERT
Last Name:SPEAR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:GILBERT
Other - Last Name:MCCREARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:36 EGLIN PKWY NE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-4915
Mailing Address - Country:US
Mailing Address - Phone:850-243-3111
Mailing Address - Fax:850-200-4373
Practice Address - Street 1:770 US HIGHWAY 331 S
Practice Address - Street 2:STE 1
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32435-3307
Practice Address - Country:US
Practice Address - Phone:850-207-2080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3920152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL68122OtherBCBS OF FL
FL112297000Medicaid
FL68122OtherBCBS OF FL
FL014488100Medicaid