Provider Demographics
NPI:1861006918
Name:SPARKS, HALEY RUTH (OD)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:RUTH
Last Name: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 1:8812 N COUNCIL RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-3246
Mailing Address - Country:US
Mailing Address - Phone:405-773-3937
Mailing Address - Fax:
Practice Address - Street 1:8812 N COUNCIL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-3246
Practice Address - Country:US
Practice Address - Phone:405-773-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-06
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3094152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist