Kristan C Sparks, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

ODP638 Issued in ID

Practice address

169 S Emerson Ave
Shelley, ID 83274-1226

Phone

(208) 357-5733

Fax

(208) 357-2240

NPI assigned

Jul 24, 2007

Last updated

Jul 24, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Pacific University - College of Optometry, 1980

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Parkway Eyecare P CGroup PAC ID 3274594932, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Parkway Eyecare PC

  dba Shelley Eyecare

  • Optometrist
  • Shelley, ID
  • NPI 1780784769
  Medicare reassignment Care Compare group NPD Authorized official
• Parkway Eyecare, P.C.

  dba Parkway Eyecare

  • Optometrist
  • Idaho Falls, ID
  • NPI 1013254549
  NPD Authorized official

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

{
    "created_epoch": "1185235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1185235200000",
    "number": "1174723332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 547",
            "city": "SHELLEY",
            "state": "ID",
            "postal_code": "832740547",
            "telephone_number": "208-357-5733",
            "fax_number": "208-357-2240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "169 S EMERSON AVE",
            "city": "SHELLEY",
            "state": "ID",
            "postal_code": "832741226",
            "telephone_number": "208-357-5733",
            "fax_number": "208-357-2240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPARKS",
        "first_name": "KRISTAN",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-24",
        "last_updated": "2007-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP638",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001251300",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VBA",
            "identifier": "90638",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010015251",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "V5988",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPECTERA",
            "identifier": "21776",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shelley Dental, Inc
• Shelley-Firth Quick Response Unit
• Samuel R Smith, DDS
• Snake River Eye Associates of Shelley, PLLC
• Aubrey Joy Snell, HEALTH COACH
• John R Stohl
• Stone Ridge Dental Inc.
• Melanie F. Sullivan, LMFT
• Corwin Sutherin
• Ty W. Swensen, PHARM.D.

• Optometrist in Shelley, ID
• Providers in Shelley, ID by specialty
• Optometrist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.