Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0800X | Contact Lens | ||
Y | 156FX1800X | Optician |
NPI | 1396131181 |
---|---|
Provider Name | Tracy Parker |
First Address | Baton Rouge, LA 70818-4288 |
Second Address | Baton Rouge, LA 70818-4288 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2015 |
Last Update Date | 25/02/2021 |