Basic Information
| Provider Information | |||||||||
| NPI: | 1760045157 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPARSCHU | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22 N TELEGRAPH RD | ||||||||
| Address2: | |||||||||
| City: | PONTIAC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483411166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483322895 | ||||||||
| FaxNumber: | 2483322896 | ||||||||
| Practice Location | |||||||||
| Address1: | 22 N TELEGRAPH RD | ||||||||
| Address2: | |||||||||
| City: | PONTIAC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483411166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483322895 | ||||||||
| FaxNumber: | 2483322896 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2019 | ||||||||
| LastUpdateDate: | 03/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 4901005360 | MI | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.