Organization
REALEYES EYE CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN SPONSELLER M.D. (OWNER)
(734) 674-4738
Entity
Organization
Contact information
Practice address
47B POLIQUIN DR, CONWAY, NH 03818-1380
(734) 674-4738
Mailing address
PO BOX 1380, CONWAY, NH 03818-1380
(734) 674-4738
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
799G
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1770862716
—
ME
Enumeration date
08/09/2011
Last updated
04/30/2012
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