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General NPI Number Information
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NPI Number | 1235689779
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Entity Type | Organization
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Legal Business Name | JENNY PARK OPTOMETRY
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Dates
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Enumeration Date | 10/07/2016
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Last Update Date | 08/18/2021
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Provider Practice Location Address
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Address Line | 6600 TOPANGA CANYON BLVD UNIT 1
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City | CANOGA PARK
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State | CA
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Zip | 91303-2601
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Country | US
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Telephone | 818-883-8220
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Fax |
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Provider Business Mailing Address
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Address Line | 6600 TOPANGA CANYON BLVD UNIT 1
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City | CANOGA PARK
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State | CA
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Zip | 91303-2601
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. JENNY PARK
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Credential |
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Telephone | 206-446-2800
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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 | 14630
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License Number State | CA
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