Provider Demographics
NPI:1134409790
Name:SPARKMAN, TIMOTHY A (OD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:A
Last Name:SPARKMAN
Suffix:
Gender:M
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:PO BOX 296
Mailing Address - Street 2:
Mailing Address - City:FERGUSON
Mailing Address - State:KY
Mailing Address - Zip Code:42533-0296
Mailing Address - Country:US
Mailing Address - Phone:606-492-2211
Mailing Address - Fax:606-676-0873
Practice Address - Street 1:3810 S HIGHWAY 27 STE 1
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-3073
Practice Address - Country:US
Practice Address - Phone:606-678-4551
Practice Address - Fax:606-678-0972
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1850DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000840902OtherANTHEM SOMERSET
KY0487990002OtherMEDICARE DME WHITLEY
KY5094OtherAVESIS WHITLEY
KY7100196570Medicaid
TN4104981OtherTENNCARE WHITLEY
KY7100209960Medicaid
KY015403OtherBLOCK SOMERSET
KY2416OtherMEDICARE SOMERSET
KY5092OtherAVESIS SOMERSET
KY8809OtherMEDICARE WHITLEY
KYCP0230:009OtherEYEMED WHITLEY
KYCP0230:010OtherEYEMED SOMERSET
KYCB8623OtherRAILROAD MEDICARE KY OFFICES
TNCJ5379OtherRAILROAD MEDICARE TN OFFICES
KY000000840905OtherANTHEM WHITLEY
KY0487990006OtherMEDICARE DME SOMERSET
TN154471OtherTENNCARE SOMERSET
KY7100212600Medicaid
KY0487990002OtherMEDICARE DME WHITLEY
TN154471OtherTENNCARE SOMERSET
KY5092OtherAVESIS SOMERSET
KY5094OtherAVESIS WHITLEY
KYK021024Medicare PIN