Healthcare Provider Details

I. General information

NPI: 1487485983
Provider Name (Legal Business Name): SPARK EYE CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 SETON PKWY STE 330
KYLE TX
78640-6179
US

IV. Provider business mailing address

1180 SETON PKWY STE 330
KYLE TX
78640-6179
US

V. Phone/Fax

Practice location:
  • Phone: 512-287-7071
  • Fax:
Mailing address:
  • Phone: 512-287-7071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREW PLUMMER
Title or Position: OWNER
Credential: MD
Phone: 210-710-1957