Provider Demographics
NPI:1598761595
Name:PARKS, MICHAEL C (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:PARKS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:325A KENNEDY MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4517
Mailing Address - Country:US
Mailing Address - Phone:207-873-2731
Mailing Address - Fax:207-873-1106
Practice Address - Street 1:16 SOMERSET PLZ
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:ME
Practice Address - Zip Code:04967-1334
Practice Address - Country:US
Practice Address - Phone:207-487-2261
Practice Address - Fax:207-487-3977
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEOPT835152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME308760099Medicaid
0222910001Medicare NSC
ME308760099Medicaid
MEU71748Medicare UPIN