Healthcare Provider Details

I. General information

NPI: 1073192100
Provider Name (Legal Business Name): JOSEPH SIK PAK OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6906 BROCKTON AVE STE 6
RIVERSIDE CA
92506-3802
US

IV. Provider business mailing address

8739 INNOVATION ST
CHINO CA
91708-9491
US

V. Phone/Fax

Practice location:
  • Phone: 800-898-2020
  • Fax: 844-897-3788
Mailing address:
  • Phone: 760-666-0790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number34773TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: