Provider Demographics
NPI:1396078994
Name:SPARKS, DAVID MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:SPARKS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4860 SOMERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056
Mailing Address - Country:US
Mailing Address - Phone:614-499-0450
Mailing Address - Fax:
Practice Address - Street 1:3174 MACK RD
Practice Address - Street 2:STE 3
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5369
Practice Address - Country:US
Practice Address - Phone:513-874-2000
Practice Address - Fax:513-672-9222
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001888152W00000X
OH6160152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00Y152H01Medicare PIN
OH00Y152H01Medicare PIN