Provider Demographics
NPI:1447760988
Name:BRIAN L. PARKER, O.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:BRIAN L. PARKER, O.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:LEMOYNE
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:951-296-1822
Mailing Address - Street 1:41720 WINCHESTER RD STE D
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-4871
Mailing Address - Country:US
Mailing Address - Phone:951-296-1822
Mailing Address - Fax:951-296-1821
Practice Address - Street 1:41720 WINCHESTER RD STE D
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-4871
Practice Address - Country:US
Practice Address - Phone:951-296-1822
Practice Address - Fax:951-296-1821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-11
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13818TLG261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center