Provider Demographics
NPI:1598759458
Name:PARRISH, GREGORY N (OD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:N
Last Name:PARRISH
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 1:215 1ST ST N
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4537
Mailing Address - Country:US
Mailing Address - Phone:863-299-8908
Mailing Address - Fax:863-299-1061
Practice Address - Street 1:4337 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1654
Practice Address - Country:US
Practice Address - Phone:863-619-6900
Practice Address - Fax:863-648-4679
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2380152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078747700Medicaid
FL078747700Medicaid
FL20232YMedicare PIN
FL20232CMedicare PIN
U09981Medicare UPIN
FL20232XMedicare PIN