=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225031628
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALAN C PARENT M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2005
-----------------------------------------------------
Last Update Date | 09/14/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29753 HOOVER RD STE A
-----------------------------------------------------
City | WARREN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48093-8900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-573-4333
-----------------------------------------------------
Fax | 586-573-2149
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29753 HOOVER RD STE A
-----------------------------------------------------
City | WARREN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48093-8900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-573-4333
-----------------------------------------------------
Fax | 586-573-2149
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 4301077542
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------