Healthcare Provider Details

I. General information

NPI: 1710229604
Provider Name (Legal Business Name): TONY PARK OD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6135 JUNCTION BLVD STE A1
REGO PARK NY
11374-2772
US

IV. Provider business mailing address

5011 216TH ST
BAYSIDE HILLS NY
11364-1362
US

V. Phone/Fax

Practice location:
  • Phone: 718-760-7862
  • Fax: 917-540-3750
Mailing address:
  • Phone: 510-366-3506
  • Fax: 917-540-3750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberTUV 007776
License Number StateNY

VIII. Authorized Official

Name: DR. TONY CHAN PARK
Title or Position: OPTOMETRIST/OWNER
Credential: OD
Phone: 510-366-3506