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NPI Code Detail

MEDICARE: TRENT ARTHUR SPONSELLER O.D.

MEDICARE: TRENT ARTHUR SPONSELLER 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
1152W00000XOptometrist3636/T661OH

General Provider Information

NPI Number : 1588776082
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRENT ARTHUR SPONSELLER O.D.
Provider Business Mailing Address
First Line : PO BOX 213
Second Line :
City : SHELBY
State : OH
Zip : 44875-0213
Country : US
Telephone Number : 419-347-1766
Fax Number : 419-627-9677
Provider Business Practice Location Address
First Line : 5500 MILAN RD
Second Line :
City : SANDUSKY
State : OH
Zip : 44870-7800
Country : US
Telephone Number : 419-627-8878
Fax Number : 419-627-9677
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 07/08/2007

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