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General NPI Number Information
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NPI Number | 1003071887
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Entity Type | Organization
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Legal Business Name | WILLIAM L PARK, OD, LLC
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Dates
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Enumeration Date | 07/22/2008
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Last Update Date | 04/14/2011
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Provider Practice Location Address
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Address Line | 610 N MAIN ST SUITE 201
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City | WICHITA
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State | KS
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Zip | 67203-3601
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Country | US
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Telephone | 316-440-1690
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Fax | 316-440-1695
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Provider Business Mailing Address
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Address Line | 610 N MAIN ST SUITE 201
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City | WICHITA
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State | KS
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Zip | 67203-3601
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Country | US
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Telephone | 316-440-1690
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Fax | 316-440-1695
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Authorized Official
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Title or Position | MEMBER
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Name | DR. WILLIAM L PARK
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Credential | OD
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Telephone | 316-440-1690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | 1798
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1798
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License Number State | KS
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