Provider Demographics
NPI:1346688801
Name:SPARKS EYE CARE LLC
Entity Type:Organization
Organization Name:SPARKS EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-499-0450
Mailing Address - Street 1:3174 MACK RD
Mailing Address - Street 2:STE. #3
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5370
Mailing Address - Country:US
Mailing Address - Phone:513-874-2000
Mailing Address - Fax:513-672-9222
Practice Address - Street 1:3174 MACK RD
Practice Address - Street 2:STE. #3
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5370
Practice Address - Country:US
Practice Address - Phone:513-874-2000
Practice Address - Fax:513-672-9222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-06
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6160152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH202480Medicare PIN