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General NPI Number Information
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NPI Number | 1902429665
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Entity Type | Individual
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Provider Name | TAYLOR MICHELLE SPRAGUE OD
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Gender | Female
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Dates
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Enumeration Date | 05/28/2020
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Last Update Date | 07/29/2022
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Provider Practice Location Address
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Address Line | 340 ALEXANDERSVILLE RD
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City | MIAMISBURG
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State | OH
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Zip | 45342-3644
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Country | US
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Telephone | 937-866-3471
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Fax |
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Provider Business Mailing Address
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Address Line | 744 E 3RD ST
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City | BLOOMINGTON
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State | IN
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Zip | 47405-3603
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Country | US
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Telephone | 812-855-8436
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Fax |
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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 | 18004213A
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License Number State | IN
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