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General NPI Number Information
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NPI Number | 1043838063
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Entity Type | Organization
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Legal Business Name | SUZAN PARK, OD PLLC
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Dates
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Enumeration Date | 07/07/2020
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Last Update Date | 07/07/2020
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Provider Practice Location Address
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Address Line | 1128 N GALLOWAY AVE
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City | MESQUITE
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State | TX
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Zip | 75149-7415
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Country | US
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Telephone | 972-288-4427
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Fax | 972-285-4240
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Provider Business Mailing Address
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Address Line | 1128 N GALLOWAY AVE
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City | MESQUITE
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State | TX
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Zip | 75149-7415
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Country | US
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Telephone | 972-288-4427
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Fax | 972-285-4240
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUZAN PARK
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Credential | OD
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Telephone | 972-288-4427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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