Provider Demographics
NPI:1285931527
Name:PARHAM, WANDA LOUISE (OD)
Entity type:Individual
Prefix:DR
First Name:WANDA
Middle Name:LOUISE
Last Name:PARHAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:WANDA
Other - Middle Name:LOUISE
Other - Last Name:PARHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:15301 WARREN SHINGLE RD
Mailing Address - Street 2:
Mailing Address - City:BEALE AFB
Mailing Address - State:CA
Mailing Address - Zip Code:95903-1905
Mailing Address - Country:US
Mailing Address - Phone:530-634-3262
Mailing Address - Fax:
Practice Address - Street 1:15301 WARREN SHINGLE RD
Practice Address - Street 2:
Practice Address - City:BEALE AFB
Practice Address - State:CA
Practice Address - Zip Code:95903-1905
Practice Address - Country:US
Practice Address - Phone:530-634-3262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-23
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5308T152W00000X
OHOPT.006177152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1285931527OtherNPI