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General NPI Number Information
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NPI Number | 1538388624
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Entity Type | Organization
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Legal Business Name | SPARHAWK VISION, CHTD
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2025 12TH AVE RD SUITE 100
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City | NAMPA
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State | ID
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Zip | 83686-6459
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Country | US
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Telephone | 208-461-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 2025 12TH AVE RD SUITE 100
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City | MAMPA
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State | ID
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Zip | 83686
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Country | US
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Telephone | 208-461-1000
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. JUSTIN DAVID SPARHAWK
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Credential | OD
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Telephone | 208-461-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | ODP-100122
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License Number State | ID
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