Provider Demographics
NPI:1407942535
Name:PARKER, CAROL B (OD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:B
Last Name:PARKER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:CAROL
Other - Middle Name:A
Other - Last Name:BRUNNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1536 STORY AVE
Mailing Address - Street 2:THE EYE CARE INSTITUTE BUILDING
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-1738
Mailing Address - Country:US
Mailing Address - Phone:502-589-1500
Mailing Address - Fax:502-589-1556
Practice Address - Street 1:2355 POPLAR LEVEL RD STE 100
Practice Address - Street 2:AUDUBON MEDICAL PLAZA WEST
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1384
Practice Address - Country:US
Practice Address - Phone:502-637-3036
Practice Address - Fax:502-637-1105
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1136DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77011369Medicaid
IN200338520Medicaid
KY1340219Medicare ID - Type Unspecified
KYT54753Medicare UPIN