Organization
PARKWAY EYECARE, P.C.
Active
Other names
Parkway Eyecare
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KRISTAN C SPARKS O.D. (OWNER)
(208) 357-5733
Entity
Organization
Contact information
Practice address
320 S WOODRUFF AVE, IDAHO FALLS, ID 83401-4329
(208) 524-4552
(208) 524-4559
Mailing address
320 S WOODRUFF AVE, IDAHO FALLS, ID 83401-4329
(208) 524-4552
(208) 524-4559
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
ODP-100034
ID
152W00000X
Optometrist
Primary
ODP-638
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806877400
—
ID
Enumeration date
01/03/2013
Last updated
03/01/2013
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