Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1300 | CO |
NPI | 1003987553 |
---|---|
Provider Name | Dr. Parker Lee Call |
First Address | Grand Junction, CO 81506-3954 |
Second Address | Grand Junction, CO 81506-3954 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 10/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
410046504 | METRA-HEALTH RR-MEDICARE (01) | CO |
56604335 | (05) | CO |
84-1571984 | TAX I.D. NUMBER (01) | CO |
T60871 | (02) | CO |