Provider Demographics
NPI:1962544817
Name:PARKS, TANYA M (OD)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:M
Last Name:PARKS
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Gender:F
Credentials:OD
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Mailing Address - Street 1:1133 E 83RD ST
Mailing Address - Street 2:UNIT # 204
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-6450
Mailing Address - Country:US
Mailing Address - Phone:773-721-7327
Mailing Address - Fax:773-721-7351
Practice Address - Street 1:5401 S WENTWORTH AVE
Practice Address - Street 2:SUITE 14B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-6300
Practice Address - Country:US
Practice Address - Phone:773-924-5297
Practice Address - Fax:773-373-3548
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist