=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568454825
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT J PARNES OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2005
-----------------------------------------------------
Last Update Date | 11/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5306 CORTEZ RD W
-----------------------------------------------------
City | BRADENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34210-2821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-794-3276
-----------------------------------------------------
Fax | 941-794-5640
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5306 CORTEZ RD W
-----------------------------------------------------
City | BRADENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34210-2821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-794-3276
-----------------------------------------------------
Fax | 941-794-5640
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OP1364
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------