Provider Demographics
NPI:1861489460
Name:PARKER, SARAH C (OD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:C
Last Name:PARKER
Suffix:
Gender:F
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:PO BOX 683
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:KY
Mailing Address - Zip Code:42445-0683
Mailing Address - Country:US
Mailing Address - Phone:270-365-6627
Mailing Address - Fax:270-365-7700
Practice Address - Street 1:101 E SHEPARDSON ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:KY
Practice Address - Zip Code:42445-1633
Practice Address - Country:US
Practice Address - Phone:270-365-6627
Practice Address - Fax:270-365-7700
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1339-DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77013399Medicaid
KY0383002Medicare PIN
KY0391780001Medicare NSC
KY77013399Medicaid
KY00621002Medicare PIN
KY410041551Medicare PIN
KYP00839569Medicare PIN