Provider Demographics
NPI:1497728935
Name:SPONSLER, TODD A (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:A
Last Name:SPONSLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E. PLEASANT VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-5530
Mailing Address - Country:US
Mailing Address - Phone:814-946-0821
Mailing Address - Fax:814-941-2520
Practice Address - Street 1:600 E. PLEASANT VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-5530
Practice Address - Country:US
Practice Address - Phone:814-946-0821
Practice Address - Fax:814-941-2520
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052425L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014681390005Medicaid
PA0014681390005Medicaid
PA769876Medicare ID - Type Unspecified