Provider Demographics
NPI:1023090594
Name:PAROD, MARTIN WILLIAM (OD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:WILLIAM
Last Name:PAROD
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 1:455 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:TN
Mailing Address - Zip Code:38583-1360
Mailing Address - Country:US
Mailing Address - Phone:931-836-6433
Mailing Address - Fax:931-836-2753
Practice Address - Street 1:455 VISTA DR
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-1360
Practice Address - Country:US
Practice Address - Phone:931-836-6433
Practice Address - Fax:931-836-2753
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD2391152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3946561Medicaid
TNOD2391OtherOD LICENSE #
TN3946561Medicaid
TNT39035Medicare UPIN
TN3946561Medicare ID - Type UnspecifiedPROVIDER #