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General NPI Number Information
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NPI Number | 1649239179
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Entity Type | Individual
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Provider Name | WILLIAM ROBERT SPRAGUE OD
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Gender | Male
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Dates
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Enumeration Date | 03/22/2006
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Last Update Date | 07/15/2008
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Provider Practice Location Address
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Address Line | 102 E STANLEY ST
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City | THORP
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State | WI
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Zip | 54771
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Country | US
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Telephone | 715-669-5631
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Fax | 715-669-5353
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Provider Business Mailing Address
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Address Line | 16126 81ST AV
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City | CHIPPEWA FALLS
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State | WI
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Zip | 54729-8883
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Country | US
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Telephone | 715-726-9510
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Fax | 715-669-5353
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1359
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License Number State | WI
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