Healthcare Provider Details

I. General information

NPI: 1134120975
Provider Name (Legal Business Name): LORIE ANN PARKS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORIE LEPLEY PARKS O.D.

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 FIRST PARK DR STE A
OAKLAND ME
04963-5370
US

IV. Provider business mailing address

25 FIRST PARK DR STE A
OAKLAND ME
04963-5370
US

V. Phone/Fax

Practice location:
  • Phone: 207-820-2020
  • Fax: 207-616-3437
Mailing address:
  • Phone: 207-820-2020
  • Fax: 207-616-3437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT834
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: