Provider Demographics
NPI:1669552048
Name:SPARHAWK, JUSTIN DAVID (OD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:DAVID
Last Name:SPARHAWK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:781 N SHADOWRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-5674
Mailing Address - Country:US
Mailing Address - Phone:208-939-3294
Mailing Address - Fax:
Practice Address - Street 1:2025 12TH AVE RD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-6459
Practice Address - Country:US
Practice Address - Phone:208-461-1000
Practice Address - Fax:208-461-0969
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-100122152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management