Provider Demographics
NPI:1225482615
Name:PARKER, CLIFFORD (OD)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 S CONGRESS AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-2111
Mailing Address - Country:US
Mailing Address - Phone:561-967-4355
Mailing Address - Fax:561-967-4466
Practice Address - Street 1:3015 S CONGRESS AVE STE 9
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-2111
Practice Address - Country:US
Practice Address - Phone:561-967-4355
Practice Address - Fax:561-967-4466
Is Sole Proprietor?:No
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZOPC836152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOPC836OtherLICENCES NUMBER