MEDICARE: DR. MICHAEL RAY PARKER 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	S468TA071	AL

Other Identifiers

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

General Provider Information

NPI Number	:	1477521698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL RAY PARKER OD

Provider Business Mailing Address
First Line	:	PO BOX 680595
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35968
Country	:	US
Telephone Number	:	256-845-6360
Fax Number	:	256-845-6364

Provider Business Practice Location Address
First Line	:	900 GAULT AVE S
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35967
Country	:	US
Telephone Number	:	256-845-6360
Fax Number	:	256-845-6364

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	06/01/2011

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