Provider Demographics
NPI:1609427418
Name:PARROTT, BRYAN THOMAS (OD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:THOMAS
Last Name:PARROTT
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 1:2024 FORD PKWY
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1992
Mailing Address - Country:US
Mailing Address - Phone:651-698-2020
Mailing Address - Fax:651-698-6918
Practice Address - Street 1:2024 FORD PKWY
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1931
Practice Address - Country:US
Practice Address - Phone:651-698-2020
Practice Address - Fax:651-698-6918
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004196A152W00000X
MN3772152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist