Provider Demographics
NPI:1538293758
Name:PARKER, DOUGLAS HOWARD (LO)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:HOWARD
Last Name:PARKER
Suffix:
Gender:M
Credentials:LO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06451-4111
Mailing Address - Country:US
Mailing Address - Phone:203-235-1681
Mailing Address - Fax:203-235-1682
Practice Address - Street 1:86 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-4111
Practice Address - Country:US
Practice Address - Phone:203-235-1681
Practice Address - Fax:203-235-1682
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000860156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician