Basic Information
| Provider Information | |||||||||
| NPI: | 1972541738 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARKER | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | ALAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6329 GALL BLVD | ||||||||
| Address2: | |||||||||
| City: | ZEPHYRHILLS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8137887616 | ||||||||
| FaxNumber: | 8137832856 | ||||||||
| Practice Location | |||||||||
| Address1: | 6329 GALL BLVD | ||||||||
| Address2: | |||||||||
| City: | ZEPHYRHILLS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8137887616 | ||||||||
| FaxNumber: | 8137832856 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 08/26/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1572DT | KY | N | Eye and Vision Services Providers | Optometrist | 152W00000X | OPC4231 | FL | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 043776809 | 01 | KY | TAX ID | OTHER | 043776809 | 01 | KY | BLUEGRASS FAMILY HEALTH | OTHER | 1223592 | 01 | KY | CHA | OTHER | 336311 | 01 | KY | AMTHEM BC/BS | OTHER | 7938741 | 01 | KY | AETNA | OTHER | 043776809 | 01 | KY | UNITED HEALTH CARE | OTHER |