Provider Demographics
NPI:1477810125
Name:TARA J PARNELL, OD PA
Entity Type:Organization
Organization Name:TARA J PARNELL, OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PARNELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:910-454-9226
Mailing Address - Street 1:1125 N HOWE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-3041
Mailing Address - Country:US
Mailing Address - Phone:910-454-9226
Mailing Address - Fax:910-454-0776
Practice Address - Street 1:1125 N HOWE ST
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-3041
Practice Address - Country:US
Practice Address - Phone:910-454-9226
Practice Address - Fax:910-454-0776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1721152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU73022Medicare UPIN