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General NPI Number Information
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NPI Number | 1548467194
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Entity Type | Organization
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Legal Business Name | KEITH B SPARKMAN
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Dates
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Enumeration Date | 06/28/2007
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Last Update Date | 01/06/2009
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Provider Practice Location Address
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Address Line | 1013 SPRING CREEK RD
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City | CHATTANOOGA
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State | TN
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Zip | 37412-3971
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Country | US
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Telephone | 423-855-8288
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Fax | 423-855-4527
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Provider Business Mailing Address
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Address Line | 1013 SPRING CREEK RD
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City | CHATTANOOGA
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State | TN
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Zip | 37412-3971
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Country | US
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Telephone | 423-855-8288
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Fax | 423-855-4527
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEITH B SPARKMAN
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Credential |
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Telephone | 423-855-8288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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