Provider Demographics
NPI:1629043732
Name:SPARR, ALBERT JOHN (O D)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:JOHN
Last Name:SPARR
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S CUSTER AVE
Mailing Address - Street 2:
Mailing Address - City:MILES CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59301-4904
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1909 MAIN ST
Practice Address - Street 2:
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:59301-3724
Practice Address - Country:US
Practice Address - Phone:406-234-7426
Practice Address - Fax:406-234-7005
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT372152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0482807Medicaid
MT0000025113Medicare UPIN
MT0482807Medicaid