Provider Demographics
NPI:1740482355
Name:PARKER, ROBERT SHARPLEY III (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SHARPLEY
Last Name:PARKER
Suffix:III
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 1:931 W RACE ST
Mailing Address - Street 2:SUITE 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:SUITE 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:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT728152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1524133Medicaid
TN103G704663Medicare PIN
TN1524133Medicaid