MEDICARE: JAMES A PARKS 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	177	AZ

General Provider Information

NPI Number	:	1578546099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES A PARKS OD

Provider Business Mailing Address
First Line	:	1110 N EL DORADO PL
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85715-4606
Country	:	US
Telephone Number	:	520-327-5677
Fax Number	:	520-325-2335

Provider Business Practice Location Address
First Line	:	1110 N EL DORADO PL
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85715-4606
Country	:	US
Telephone Number	:	520-327-5677
Fax Number	:	520-325-2335

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

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	10/10/2007

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