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NPI Code Detail

MEDICARE: DR. DAVID J. PARKER, JR.

MEDICARE: DR. DAVID J. PARKER, JR.
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
1152W00000XOptometrist534MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1376717215
Entity Type Code : Organization
Provider Name (Legal Business Name) : DR. DAVID J. PARKER, JR.
Provider Business Mailing Address
First Line : PO BOX 202
Second Line :
City : YAZOO CITY
State : MS
Zip : 39194-0202
Country : US
Telephone Number : 662-746-1623
Fax Number : 662-746-4397
Provider Business Practice Location Address
First Line : 110 N JERRY CLOWER BLVD
Second Line : SUITE H
City : YAZOO CITY
State : MS
Zip : 39194-8669
Country : US
Telephone Number : 662-746-1623
Fax Number : 662-746-4397
Authorized Official
Title or Position : OPTOMETRIST
Name : DAVID JASPER PARKER JR.
Credential : OD
Telephone Number : 662-746-1623
Provider Enumeration Date : 04/22/2008
Last Update Date : 06/17/2008

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