Provider Demographics
NPI:1154471712
Name:PARKER-HOWAYECK, TINA M (OD)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:M
Last Name:PARKER-HOWAYECK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:16 FAIRHAVEN COMMONS WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-4627
Mailing Address - Country:US
Mailing Address - Phone:508-999-4401
Mailing Address - Fax:508-992-3937
Practice Address - Street 1:16 FAIRHAVEN COMMONS WAY
Practice Address - Street 2:
Practice Address - City:FAIRHAVEN
Practice Address - State:MA
Practice Address - Zip Code:02719-4627
Practice Address - Country:US
Practice Address - Phone:508-999-4401
Practice Address - Fax:508-992-3937
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4078152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0334740Medicaid
MA152869OtherHARVARD PILGRIM
MAW17265OtherBLUE CROSS BLUE SHIELDS
MA0027335OtherNEIGHBORHOOD HEALTH PLAN
MA0334740Medicaid
MAW1726501Medicare PIN