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General NPI Number Information
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NPI Number | 1437494572
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Entity Type | Organization
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Legal Business Name | KELLI L. PARKS, OD, LLC
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Dates
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Enumeration Date | 11/30/2012
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Last Update Date | 11/30/2012
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Provider Practice Location Address
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Address Line | 740 BEAL PKWY NW
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-3002
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Country | US
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Telephone | 850-585-8830
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 874
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City | NICEVILLE
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State | FL
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Zip | 32588-0874
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Country | US
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Telephone | 850-585-8830
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. KELLI L PARKS
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Credential | OD
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Telephone | 850-585-8830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC3149
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License Number State | FL
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