Individual
DR. JEFFERY L SPONSELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
3152 WASHINGTON RD, AUGUSTA, GA 30907
(706) 651-1291
(706) 210-8090
Mailing address
3152 WASHINGTON RD, AUGUSTA, GA 30907
(706) 651-1291
(706) 210-8090
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1425
SC
152W00000X
Optometrist
Primary
OPT002159
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
519944203B
—
GA
05
—
DG2159
—
SC
Enumeration date
05/03/2006
Last updated
06/15/2012
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