Provider Demographics
NPI:1346436003
Name:PARKS, ROCHELLE KATHLEEN (OD)
Entity Type:Individual
Prefix:DR
First Name:ROCHELLE
Middle Name:KATHLEEN
Last Name:PARKS
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:PO BOX 1449
Mailing Address - Street 2:
Mailing Address - City:DUNLAP
Mailing Address - State:TN
Mailing Address - Zip Code:37327-1449
Mailing Address - Country:US
Mailing Address - Phone:423-949-3937
Mailing Address - Fax:423-949-8329
Practice Address - Street 1:15247 RANKIN AVE.
Practice Address - Street 2:
Practice Address - City:DUNLAP
Practice Address - State:TN
Practice Address - Zip Code:37327
Practice Address - Country:US
Practice Address - Phone:423-949-3937
Practice Address - Fax:423-949-8329
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-17
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2738152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist