Provider Demographics
NPI:1245543719
Name:ROBERT S. PARKER, III, O.D., PLLC
Entity type:Organization
Organization Name:ROBERT S. PARKER, III, O.D., PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SHARPLEY
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:III
Authorized Official - Credentials:OD
Authorized Official - Phone:865-248-8130
Mailing Address - Street 1:931 W RACE ST
Mailing Address - Street 2:STE A
Mailing Address - City:KINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:37763-2123
Mailing Address - Country:US
Mailing Address - Phone:865-248-8130
Mailing Address - Fax:
Practice Address - Street 1:931 W RACE ST
Practice Address - Street 2:STE A
Practice Address - City:KINGSTON
Practice Address - State:TN
Practice Address - Zip Code:37763-2123
Practice Address - Country:US
Practice Address - Phone:865-248-8130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT728261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center