Healthcare Provider Details

I. General information

NPI: 1235246984
Provider Name (Legal Business Name): STEVE B. PARK, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 04/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 BUFFALO RD BLDG 700
ROCHESTER NY
14624-1367
US

IV. Provider business mailing address

2300 BUFFALO RD BLDG 700
ROCHESTER NY
14624-1367
US

V. Phone/Fax

Practice location:
  • Phone: 585-328-0153
  • Fax: 585-328-0158
Mailing address:
  • Phone: 585-328-0153
  • Fax: 585-328-0158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV004649-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT005400-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV003238-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number182420-1
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number156287-2
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number198945-1
License Number StateNY
# 8
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number083720-1
License Number StateNY
# 9
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV005295-1
License Number StateNY

VIII. Authorized Official

Name: DR. STEVE B. PARK
Title or Position: OWNER
Credential: M.D.
Phone: 585-328-0153