Provider Demographics
NPI:1164872727
Name:SPARKS, EMILY A (OD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:A
Last Name:SPARKS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 PLEASANT WAY
Mailing Address - Street 2:
Mailing Address - City:UNION DALE
Mailing Address - State:PA
Mailing Address - Zip Code:18470-7522
Mailing Address - Country:US
Mailing Address - Phone:570-574-1808
Mailing Address - Fax:
Practice Address - Street 1:200 MIFFLIN AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503
Practice Address - Country:US
Practice Address - Phone:570-340-8053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003171152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031329910002Medicaid