Provider Demographics
NPI:1972541738
Name:PARKER, TIMOTHY ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ALAN
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 1:956 MINING GAP LN
Mailing Address - Street 2:
Mailing Address - City:YOUNG HARRIS
Mailing Address - State:GA
Mailing Address - Zip Code:30582-2324
Mailing Address - Country:US
Mailing Address - Phone:813-995-7577
Mailing Address - Fax:706-515-2021
Practice Address - Street 1:118 VISION DR
Practice Address - Street 2:
Practice Address - City:CORNELIA
Practice Address - State:GA
Practice Address - Zip Code:30531-5737
Practice Address - Country:US
Practice Address - Phone:706-776-2020
Practice Address - Fax:706-776-7243
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4231152W00000X
KY1572DT152W00000X
GAOPT002112152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1223592OtherCHA
KY7938741OtherAETNA
KY043776809OtherUNITED HEALTH CARE
KY043776809OtherBLUEGRASS FAMILY HEALTH
KY043776809OtherTAX ID
KY336311OtherAMTHEM BC/BS
KY043776809OtherUNITED HEALTH CARE
KY043776809OtherBLUEGRASS FAMILY HEALTH