Provider Demographics
NPI:1164483673
Name:PARKIN, DESMOND (OD)
Entity Type:Individual
Prefix:DR
First Name:DESMOND
Middle Name:
Last Name:PARKIN
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 1:196 PROSPECT PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-3802
Mailing Address - Country:US
Mailing Address - Phone:718-623-9122
Mailing Address - Fax:718-623-9128
Practice Address - Street 1:196 PROSPECT PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-3802
Practice Address - Country:US
Practice Address - Phone:718-623-9122
Practice Address - Fax:718-623-9122
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-01
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0049261152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01110094Medicaid
NYU17993Medicare UPIN
NY01110094Medicaid
NYC40941Medicare PIN