Individual
BERNARD I SPARKS III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
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
Update your record
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