Healthcare Provider Details

I. General information

NPI: 1174367197
Provider Name (Legal Business Name): PARKER TODD MONSEN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MCKINLEY AVE NW
CANTON OH
44703-2463
US

IV. Provider business mailing address

800 MCKINLEY AVE NW
CANTON OH
44703-2463
US

V. Phone/Fax

Practice location:
  • Phone: 330-452-8884
  • Fax:
Mailing address:
  • Phone: 330-452-8884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.007402
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2024020286
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: