Healthcare Provider Details

I. General information

NPI: 1417265372
Provider Name (Legal Business Name): SHERI M. SPARKS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 NORTHWESTERN DR STE 400
BLOOMFIELD CT
06002-3444
US

IV. Provider business mailing address

530 BUSHY HILL RD SUITE 150
SIMSBURY CT
06070-2995
US

V. Phone/Fax

Practice location:
  • Phone: 860-243-2020
  • Fax: 860-243-5190
Mailing address:
  • Phone: 860-651-3403
  • Fax: 860-651-5919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number3975
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number002649
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2649
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: