Provider Demographics
NPI:1093870545
Name:PARKS, ROBERT CRAIG (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CRAIG
Last Name:PARKS
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 1:294 CAFFERTY RD
Mailing Address - Street 2:
Mailing Address - City:PIPERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18947
Mailing Address - Country:US
Mailing Address - Phone:215-354-0202
Mailing Address - Fax:215-354-0303
Practice Address - Street 1:130 ALMSHOUSE RD
Practice Address - Street 2:SUITE 403
Practice Address - City:RICHBORO
Practice Address - State:PA
Practice Address - Zip Code:18954-1100
Practice Address - Country:US
Practice Address - Phone:215-354-0202
Practice Address - Fax:215-354-0303
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA7568-T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPA136347Medicare PIN
U46614Medicare UPIN
PA136347Medicare ID - Type Unspecified