Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 3041 | TN |
NPI | 1013263474 |
---|---|
Provider Name | Chase Terrell Parker |
First Address | Memphis, TN 38104-3966 |
Second Address | Memphis, TN 38104-2127 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2012 |
Last Update Date | 02/08/2012 |