Provider Demographics
NPI:1063526432
Name:PARKER, HAROLD BRENT (OD)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:BRENT
Last Name:PARKER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E 200 N
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-2144
Mailing Address - Country:US
Mailing Address - Phone:435-896-2020
Mailing Address - Fax:435-893-2174
Practice Address - Street 1:120 E 200 N
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-2144
Practice Address - Country:US
Practice Address - Phone:435-896-2020
Practice Address - Fax:435-893-2174
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4740887-9934152W00000X
UT4740887-8904152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT4444560001Medicare NSC
UTU81415Medicare UPIN
UT000012331Medicare ID - Type Unspecified