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General NPI Number Information
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NPI Number | 1558591545
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Entity Type | Individual
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Provider Name | BRIAN LEMOYNE PARKER O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/23/2009
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Last Update Date | 07/23/2009
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Provider Practice Location Address
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Address Line | 23905 CLINTON KEITH RD STE 115
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City | WILDOMAR
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State | CA
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Zip | 92595-7897
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Country | US
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Telephone | 951-304-9733
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Fax | 866-741-5945
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Provider Business Mailing Address
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Address Line | 23905 CLINTON KEITH RD STE 115
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City | WILDOMAR
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State | CA
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Zip | 92595-7897
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Country | US
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Telephone | 951-304-9733
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Fax | 866-741-5945
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 13818
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License Number State | CA
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