Provider Demographics
NPI:1003818295
Name:PARSON, CAMILLA RUTH (MD)
Entity Type:Individual
Prefix:
First Name:CAMILLA
Middle Name:RUTH
Last Name:PARSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16820 FRANCES ST
Mailing Address - Street 2:STE 100
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130
Mailing Address - Country:US
Mailing Address - Phone:402-933-6600
Mailing Address - Fax:402-933-7123
Practice Address - Street 1:16820 FRANCES ST
Practice Address - Street 2:STE 100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130
Practice Address - Country:US
Practice Address - Phone:402-933-6600
Practice Address - Fax:402-933-7123
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17084207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025802200Medicaid
IA2944058Medicaid
NE10025058900Medicaid
NE10025802200Medicaid
NE10025058900Medicaid
NEE28758Medicare UPIN