MEDICARE: PARKER PRATT OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2776	AR

General Provider Information

NPI Number	:	1154807162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PARKER PRATT OD

Provider Business Mailing Address
First Line	:	3312 S 70TH ST
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-5052
Country	:	US
Telephone Number	:	479-452-7800
Fax Number	:	479-452-9486

Provider Business Practice Location Address
First Line	:	3312 S 70TH ST
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-5052
Country	:	US
Telephone Number	:	479-452-7800
Fax Number	:	479-452-9486

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2018
Last Update Date	:	07/12/2018

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Directions to “ PARKER PRATT OD” Practice Location

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