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General NPI Number Information
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NPI Number | 1669552048
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Entity Type | Individual
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Provider Name | JUSTIN DAVID SPARHAWK OD
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Gender | Male
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2025 12TH AVE RD
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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 | 208-461-0969
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Provider Business Mailing Address
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Address Line | 781 N SHADOWRIDGE AVE
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City | EAGLE
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State | ID
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Zip | 83616-5674
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Country | US
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Telephone | 208-939-3294
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | ODP-100122
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License Number State | ID
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Taxonomy #2
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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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