Provider Demographics
NPI:1558591545
Name:PARKER, BRIAN LEMOYNE (OD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:LEMOYNE
Last Name:PARKER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23905 CLINTON KEITH RD
Mailing Address - Street 2:STE 115
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-7897
Mailing Address - Country:US
Mailing Address - Phone:951-304-9733
Mailing Address - Fax:866-741-5945
Practice Address - Street 1:23905 CLINTON KEITH RD
Practice Address - Street 2:STE 115
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-7897
Practice Address - Country:US
Practice Address - Phone:951-304-9733
Practice Address - Fax:866-741-5945
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13818152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist