Provider Demographics
NPI:1083231740
Name:PARMER, JOHN TYLER (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:TYLER
Last Name:PARMER
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 1:855 S MAIN ST APT 211
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-3278
Mailing Address - Country:US
Mailing Address - Phone:517-483-3115
Mailing Address - Fax:
Practice Address - Street 1:22395 EUREKA RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-6016
Practice Address - Country:US
Practice Address - Phone:734-324-0996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005454152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist