Healthcare Provider Details

I. General information

NPI: 1811738677
Provider Name (Legal Business Name): OLIVIA MITCHELL PARKER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2024
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 E POPLAR AVE
SELMER TN
38375-1828
US

IV. Provider business mailing address

65 HAC ST
SAVANNAH TN
38372-1836
US

V. Phone/Fax

Practice location:
  • Phone: 731-434-3401
  • Fax:
Mailing address:
  • Phone: 731-610-5808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3913
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: