Provider Demographics
NPI:1932152147
Name:PARKS, ROBERT JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:PARKS
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 1:120 LAMBERT LIND HWY # 7
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886
Mailing Address - Country:US
Mailing Address - Phone:401-741-6810
Mailing Address - Fax:401-921-3634
Practice Address - Street 1:120 LAMBERT LIND HWY #7
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886
Practice Address - Country:US
Practice Address - Phone:401-738-0606
Practice Address - Fax:401-921-3634
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3170152W00000X
RIODTG00465152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIODTG00465OtherLICENSE NUMBER
RIRP41347Medicaid
RIRP41347Medicaid
RIT79287Medicare UPIN