Provider Demographics
NPI:1225120603
Name:PARKER, MARC E (OD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:E
Last Name:PARKER
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 1:51663 STONEHAM WAY
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-8495
Mailing Address - Country:US
Mailing Address - Phone:574-277-6896
Mailing Address - Fax:
Practice Address - Street 1:51663 STONEHAM WAY
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-8495
Practice Address - Country:US
Practice Address - Phone:574-277-6896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2092152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist