Provider Demographics
NPI:1548274921
Name:PARKER, TRACI CAMILLE (OD)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:CAMILLE
Last Name:PARKER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15808 GARRISON CIR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-3005
Mailing Address - Country:US
Mailing Address - Phone:512-733-7247
Mailing Address - Fax:
Practice Address - Street 1:2601 S I H 35 STE C100
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-7336
Practice Address - Country:US
Practice Address - Phone:512-246-3937
Practice Address - Fax:512-310-7951
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5880TG152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G5315Medicare ID - Type Unspecified