Provider Demographics
NPI:1134120975
Name:PARKS, LORIE ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:LORIE
Middle Name:ANN
Last Name:PARKS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LORIE
Other - Middle Name:LEPLEY
Other - Last Name:PARKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:25 FIRST PARK DR STE A
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04963-5370
Mailing Address - Country:US
Mailing Address - Phone:207-820-2020
Mailing Address - Fax:207-616-3437
Practice Address - Street 1:25 FIRST PARK DR STE A
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:ME
Practice Address - Zip Code:04963-5370
Practice Address - Country:US
Practice Address - Phone:207-820-2020
Practice Address - Fax:207-616-3437
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT834152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME267300099Medicaid
U81179Medicare UPIN
0222910001Medicare NSC
MEMM838401Medicare PIN