Provider Demographics
NPI:1316099120
Name:PARKER, MICHAEL R (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
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 1:2091 W US HIGHWAY 22 AND 3
Mailing Address - Street 2:
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039-9401
Mailing Address - Country:US
Mailing Address - Phone:513-677-8866
Mailing Address - Fax:513-677-9113
Practice Address - Street 1:2091 W US HIGHWAY 22 AND 3
Practice Address - Street 2:
Practice Address - City:MAINEVILLE
Practice Address - State:OH
Practice Address - Zip Code:45039-9401
Practice Address - Country:US
Practice Address - Phone:513-677-8866
Practice Address - Fax:513-677-9113
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4673152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0218259Medicaid
OH0218259Medicaid
OHU60063Medicare UPIN