Provider Demographics
NPI:1053462218
Name:PARKER, KENNETH R (OD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
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 1:3932 BEROT ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-3006
Mailing Address - Country:US
Mailing Address - Phone:504-453-8762
Mailing Address - Fax:
Practice Address - Street 1:2171 ONEAL LN
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-3206
Practice Address - Country:US
Practice Address - Phone:225-751-3755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA701-190T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1163171Medicaid
LA48020Medicare ID - Type Unspecified
LAT19492Medicare UPIN