NPIMap

Organization Active NPI

Parkway Eyecare, P.C.

  • Optometrist
  • Idaho Falls, ID
National Provider Identifier
1013254549
Registry record updated Mar 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
ODP-638 Issued in ID
Legal business name
PARKWAY EYECARE, P.C.
Practice address
320 S Woodruff Ave
Idaho Falls, ID 83401-4329
Phone
(208) 524-4552
Fax
(208) 524-4559
NPI assigned
Jan 3, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Kristan C Sparks, O.D.NPI 1174723332
Title
Owner
Phone
(208) 357-5733

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X ODP-638 ID Primary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X ODP-100034 ID

Addresses

Primary practice location

320 S Woodruff Ave
Idaho Falls, ID 83401-4329

Mailing address

320 S Woodruff Ave
Idaho Falls, ID 83401-4329
Phone (208) 524-4552

Other identifiers 1

IdentifierTypeStateIssuer
806877400MedicaidID

Other names 1

  • Parkway Eyecare Doing business as

National Provider Directory

National Provider Directory

Locations

320 S Woodruff Ave
Idaho Falls, ID 83401
Phone (208) 357-5733

169 S Emerson Ave
Shelley, ID 83274
Phone (208) 357-5733

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1357171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362096000000",
    "number": "1013254549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 S WOODRUFF AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834014329",
            "telephone_number": "208-524-4552",
            "fax_number": "208-524-4559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 S WOODRUFF AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834014329",
            "telephone_number": "208-524-4552",
            "fax_number": "208-524-4559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARKWAY EYECARE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-03",
        "last_updated": "2013-03-01",
        "status": "A",
        "authorized_official_last_name": "SPARKS",
        "authorized_official_first_name": "KRISTAN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-357-5733",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP-638",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP-100034",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806877400",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Parkway Eyecare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Idaho Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.