Provider Demographics
NPI:1275175226
Name:SPRAGUE, AMANDA E (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:E
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7514 HAZELCREST DR
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-2204
Mailing Address - Country:US
Mailing Address - Phone:417-895-8168
Mailing Address - Fax:
Practice Address - Street 1:7514 HAZELCREST DR
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-2204
Practice Address - Country:US
Practice Address - Phone:417-895-8168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician