Individual
BERNARD I SPARKS III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1225 MADISON AVE, MEMPHIS, TN 38104-2211
(901) 722-3250
(901) 722-3347
Mailing address
1225 MADISON AVE, MEMPHIS, TN 38104-2211
(901) 722-3250
(901) 722-3347
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
641
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35970641
—
TN
05
—
3597066
—
TN
01
—
4176592
BLUE CROSS BLUE SHIELD OF TENNESSEE
TN
01
—
641
OD
TN
01
—
P00103804
RAILROAD MEDICARE
TN
Enumeration date
08/24/2005
Last updated
03/07/2023
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