Provider Demographics
NPI:1588776082
Name:SPONSELLER, TRENT ARTHUR (OD)
Entity type:Individual
Prefix:
First Name:TRENT
Middle Name:ARTHUR
Last Name:SPONSELLER
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:PO BOX 213
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:OH
Mailing Address - Zip Code:44875-0213
Mailing Address - Country:US
Mailing Address - Phone:419-347-1766
Mailing Address - Fax:419-627-9677
Practice Address - Street 1:5500 MILAN RD
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-7800
Practice Address - Country:US
Practice Address - Phone:419-627-8878
Practice Address - Fax:419-627-9677
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3636/T661152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist