Provider Demographics
NPI:1477523504
Name:NEWCOME-SPARKS, CAROLYN J (OD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:J
Last Name:NEWCOME-SPARKS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CALENDAR CT
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2325
Mailing Address - Country:US
Mailing Address - Phone:708-354-0500
Mailing Address - Fax:708-354-0576
Practice Address - Street 1:100 CALENDAR CT
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-2325
Practice Address - Country:US
Practice Address - Phone:708-354-0500
Practice Address - Fax:708-354-0576
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0046007449152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist