Provider Demographics
NPI:1932160728
Name:PARKER, JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
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 1:135 ANNAPOLIS BEND CIR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-6749
Mailing Address - Country:US
Mailing Address - Phone:832-524-8350
Mailing Address - Fax:
Practice Address - Street 1:520 RIVERGATE PKWY
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2030
Practice Address - Country:US
Practice Address - Phone:615-859-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6609TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174362702Medicaid
TX81314QOtherBLUE SHIELD
TXP00250663OtherRR/MEDICARE
TX81314QOtherBLUE SHIELD
TX8D5687Medicare ID - Type Unspecified