Provider Demographics
NPI:1851422158
Name:PARNELL, TARA JEAN (OD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:JEAN
Last Name:PARNELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1456 N HOWE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-2754
Mailing Address - Country:US
Mailing Address - Phone:910-454-9458
Mailing Address - Fax:910-454-0776
Practice Address - Street 1:1456 N HOWE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-2754
Practice Address - Country:US
Practice Address - Phone:910-454-9458
Practice Address - Fax:910-454-0776
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC1721152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU73022Medicare UPIN