Provider Demographics
NPI:1902097066
Name:J. ANNETTE PARKER-HERRIOTT, O.D., P.C,.
Entity Type:Organization
Organization Name:J. ANNETTE PARKER-HERRIOTT, O.D., P.C,.
Other - Org Name:ENVISION EYE CARE - DR. J. A. PARKER & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAKELYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:PARKER-HERRIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:912-927-0707
Mailing Address - Street 1:PO BOX 16143
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-2843
Mailing Address - Country:US
Mailing Address - Phone:912-927-0707
Mailing Address - Fax:912-927-0677
Practice Address - Street 1:321 W MONTGOMERY XRD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3392
Practice Address - Country:US
Practice Address - Phone:912-927-0707
Practice Address - Fax:912-927-0677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001403152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP 4804Medicare PIN
GA1256340001Medicare NSC
GAU49378Medicare UPIN