MEDICARE: ROMY PARK OD PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	522	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	26488	OTHER	NV	MEDICAL EYE SERVICES
2	56000	OTHER	NV	DAVIS
3	291059	OTHER	NV	NVA
4	35421	OTHER	NV	AVESIS
5	1841402385	OTHER		EYEMED
6	26034	OTHER	NV	SPECTERA

General Provider Information

NPI Number	:	1841402385
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROMY PARK OD PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 401240
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89140-1240
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3615 S RAINBOW BLVD STE 1
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-1057
Country	:	US
Telephone Number	:	702-641-2007
Fax Number	:	702-258-2006

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROMY PARK
Credential	:	O.D.
Telephone Number	:	702-641-2007

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	10/28/2024

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