Provider Demographics
NPI:1841820792
Name:PARKER, CLIFFORD (OD)
Entity type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:
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 1:1202 W 200 N UNIT C206
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-3545
Mailing Address - Country:US
Mailing Address - Phone:219-789-4572
Mailing Address - Fax:
Practice Address - Street 1:4283 HARRISON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3101
Practice Address - Country:US
Practice Address - Phone:219-789-4572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-20
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11610912-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist