Provider Demographics
NPI:1851555379
Name:PARKER, JEAN SUZANNE (OD)
Entity Type:Individual
Prefix:MISS
First Name:JEAN
Middle Name:SUZANNE
Last Name:PARKER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MISS
Other - First Name:JEAN
Other - Middle Name:SUZANNE
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:719 GREEN VALLEY RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7014
Mailing Address - Country:US
Mailing Address - Phone:336-230-1010
Mailing Address - Fax:336-230-1019
Practice Address - Street 1:719 GREEN VALLEY RD
Practice Address - Street 2:SUITE 105
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7014
Practice Address - Country:US
Practice Address - Phone:336-230-1010
Practice Address - Fax:336-230-1019
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2096152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management