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General NPI Number Information
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NPI Number | 1962544817
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Entity Type | Individual
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Provider Name | TANYA M PARKS O.D.
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Gender | Female
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5401 S WENTWORTH AVE SUITE 14B
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City | CHICAGO
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State | IL
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Zip | 60609-6300
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Country | US
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Telephone | 773-924-5297
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Fax | 773-373-3548
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Provider Business Mailing Address
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Address Line | 1133 E 83RD ST UNIT # 204
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City | CHICAGO
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State | IL
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Zip | 60619-6450
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Country | US
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Telephone | 773-721-7327
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Fax | 773-721-7351
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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 |
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License Number State | IL
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