Provider Demographics
NPI:1366510513
Name:PARKER, JANET T (OD)
Entity type:Individual
Prefix:DR
First Name:JANET
Middle Name:T
Last Name:PARKER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-5509
Mailing Address - Country:US
Mailing Address - Phone:865-977-7499
Mailing Address - Fax:865-977-0920
Practice Address - Street 1:1735 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-5509
Practice Address - Country:US
Practice Address - Phone:865-977-7499
Practice Address - Fax:865-977-0920
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1029152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3596111Medicare ID - Type Unspecified
TN0125750001Medicare NSC
TNT61288Medicare UPIN