Organization
PARKWAY EYECARE PC
Active
Other names
Shelley Eyecare
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KRISTAN C SPARKS OD (OPTOMETRIST)
(208) 357-5733
Entity
Organization
Contact information
Practice address
524 N STATE ST, SHELLEY, ID 83274-1154
(208) 357-5733
(208) 357-2240
Mailing address
524 N STATE ST, SHELLEY, ID 83274-1154
(208) 357-5733
(208) 357-2240
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
09/22/2006
Last updated
04/27/2016
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