Provider Demographics
NPI:1194745463
Name:PARKER, BILL DAN (OD)
Entity type:Individual
Prefix:DR
First Name:BILL
Middle Name:DAN
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 1:1157 N YORK ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-2520
Mailing Address - Country:US
Mailing Address - Phone:918-683-8404
Mailing Address - Fax:
Practice Address - Street 1:1157 N YORK ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-2520
Practice Address - Country:US
Practice Address - Phone:918-683-8404
Practice Address - Fax:918-687-4469
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1161152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100766150AMedicaid
OK100766150AMedicaid
OK0198370001Medicare NSC