Provider Demographics
NPI:1366620734
Name:PARKER OPTICAL
Entity type:Organization
Organization Name:PARKER OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:928-669-6971
Mailing Address - Street 1:1317 S JOSHUA AVE
Mailing Address - Street 2:# H
Mailing Address - City:PARKER
Mailing Address - State:AZ
Mailing Address - Zip Code:85344-5754
Mailing Address - Country:US
Mailing Address - Phone:928-669-6971
Mailing Address - Fax:928-669-8901
Practice Address - Street 1:1317 S JOSHUA AVE
Practice Address - Street 2:# H
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344-5754
Practice Address - Country:US
Practice Address - Phone:928-669-6971
Practice Address - Fax:928-669-8901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ721332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier