Provider Demographics
NPI:1215009832
Name:SPRAGUE, LAMONT MARK (OD)
Entity Type:Individual
Prefix:DR
First Name:LAMONT
Middle Name:MARK
Last Name:SPRAGUE
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 1:300 MEMORIAL DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6278
Mailing Address - Country:US
Mailing Address - Phone:815-459-7110
Mailing Address - Fax:815-459-7138
Practice Address - Street 1:300 MEMORIAL DR
Practice Address - Street 2:SUITE 300
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6278
Practice Address - Country:US
Practice Address - Phone:815-459-7110
Practice Address - Fax:815-459-7138
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046007026152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT35308Medicare UPIN
IL206440Medicare ID - Type Unspecified