Provider Demographics
NPI:1720021967
Name:PARKER, LONGLEY LYNN (OD)
Entity Type:Individual
Prefix:
First Name:LONGLEY
Middle Name:LYNN
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 1:600 S SAINT VRAIN AVE
Mailing Address - Street 2:#5
Mailing Address - City:ESTES PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80517-7488
Mailing Address - Country:US
Mailing Address - Phone:970-586-4418
Mailing Address - Fax:970-586-0363
Practice Address - Street 1:600 S SAINT VRAIN AVE
Practice Address - Street 2:#5
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517-7488
Practice Address - Country:US
Practice Address - Phone:970-586-4418
Practice Address - Fax:970-586-0363
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO2195152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO4436580001Medicare NSC
COC811939Medicare PIN
COT71267Medicare UPIN