MEDICARE: DR. BRADLEY DOMINICK SPARKS O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OEG003190	PA

General Provider Information

NPI Number	:	1518316694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADLEY DOMINICK SPARKS O.D.

Provider Business Mailing Address
First Line	:	3319 LAKE ARIEL HWY
Second Line	:
City	:	HONESDALE
State	:	PA
Zip	:	18431-1174
Country	:	US
Telephone Number	:	570-253-6551
Fax Number	:	570-253-6553

Provider Business Practice Location Address
First Line	:	3319 LAKE ARIEL HWY
Second Line	:
City	:	HONESDALE
State	:	PA
Zip	:	18431-1174
Country	:	US
Telephone Number	:	570-253-6551
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2016
Last Update Date	:	06/25/2026

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