Sponseller, Tracie L
Sponseller, Tracie L is an sole proprietor health care provider with primary practice located at 3152 Washington Rd , Augusta GA 30907-3891. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Sponseller, Tracie L can be contacted via phone (706) 651-1291.Contact Information
Primary practice address
3152 Washington Rd
Augusta GA 30907-3891
Phone: (706) 651-1291
Fax: (706) 210-8090
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | OPT002160 | Georgia |
Profile Details
| NPI number | 1861400517 |
|---|---|
| LBN Legal business name | Sponseller, Tracie L |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 4th, 2006 |
| Last updated | Mar 10th, 2014 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1861400517 | NPPES |
| Georgia | MEDICAID | 329735702C | |
| Georgia | MEDICAID | 329735702A |
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