Provider Demographics
NPI:1437741758
Name:DR. KIMBERLY PARKS OD PLLC
Entity Type:Organization
Organization Name:DR. KIMBERLY PARKS OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:865-310-7565
Mailing Address - Street 1:3011 BELL RD
Mailing Address - Street 2:
Mailing Address - City:WHITE PINE
Mailing Address - State:TN
Mailing Address - Zip Code:37890-3102
Mailing Address - Country:US
Mailing Address - Phone:865-310-7565
Mailing Address - Fax:
Practice Address - Street 1:1903 MAPLE ST
Practice Address - Street 2:
Practice Address - City:WHITE PINE
Practice Address - State:TN
Practice Address - Zip Code:37890-3847
Practice Address - Country:US
Practice Address - Phone:865-761-0557
Practice Address - Fax:865-761-0417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-08
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty