MEDICARE: DR. ARTHUR CHUL PARK O.D.

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	0618002161	VA
2	152W00000X	Optometrist	OPT002804	GA

General Provider Information

NPI Number	:	1932464013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARTHUR CHUL PARK O.D.

Provider Business Mailing Address
First Line	:	600 GARSON DR NE
Second Line	:	APT 4104
City	:	ATLANTA
State	:	GA
Zip	:	30324-3361
Country	:	US
Telephone Number	:	206-802-4984
Fax Number	:

Provider Business Practice Location Address
First Line	:	1215 CAROLINE ST NE STE H100
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30307-2775
Country	:	US
Telephone Number	:	404-522-8886
Fax Number	:	404-522-8887

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2012
Last Update Date	:	03/01/2016

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