Individual
KEITH BRIAN SPARKMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODT1603
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2240306
UNITED HEALTH
—
01
—
3088639
BLUE CROSS BLUE SHIELD
—
05
—
3599732
—
TN
01
—
410040394
MEDICARE RAILROAD
—
Enumeration date
12/18/2006
Last updated
04/28/2008
Update your record
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