Individual
DR. TRACIE L SPONSELLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
3152 WASHINGTON RD, AUGUSTA, GA 30907-3891
(706) 651-1291
(706) 210-8090
Mailing address
3152 WASHINGTON RD, AUGUSTA, GA 30907-3891
(706) 651-1291
(706) 210-8090
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT002160
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
329735702A
—
GA
05
—
329735702C
—
GA
Enumeration date
08/04/2006
Last updated
03/10/2014
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