Provider Demographics
NPI:1255493599
Name:PARKS, JOSEPH KYLE (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:KYLE
Last Name:PARKS
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 1:127 VILLAGE DR
Mailing Address - Street 2:STE 300
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-9617
Mailing Address - Country:US
Mailing Address - Phone:406-388-9661
Mailing Address - Fax:406-388-9662
Practice Address - Street 1:127 VILLAGE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-9617
Practice Address - Country:US
Practice Address - Phone:406-388-9661
Practice Address - Fax:406-388-9662
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT774152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000028301OtherBCBS MONTANA PROVIDER ID
MT000028301OtherBCBS BLUECHIP ID
MT203416109OtherFEDERAL TAX ID
MT0483701Medicaid
MT203416109OtherFEDERAL TAX ID
MTV02590Medicare UPIN