MEDICARE: DR. RICHARD D SPROUSE OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1050	SC

General Provider Information

NPI Number	:	1548264575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD D SPROUSE OD

Provider Business Mailing Address
First Line	:	180 N DEAN ST
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29302-1517
Country	:	US
Telephone Number	:	864-583-3125
Fax Number	:	864-542-1367

Provider Business Practice Location Address
First Line	:	180 N DEAN ST
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29302-1517
Country	:	US
Telephone Number	:	864-583-3125
Fax Number	:	864-542-1367

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	01/14/2011

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