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General NPI Number Information
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NPI Number | 1366568701
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Entity Type | Individual
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Provider Name | HERRI C PARK O.D.
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Gender | Female
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 10/27/2016
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Provider Practice Location Address
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Address Line | 5437 N LINCOLN AVE
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City | CHICAGO
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State | IL
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Zip | 60625-2222
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Country | US
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Telephone | 773-561-1199
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Fax |
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Provider Business Mailing Address
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Address Line | 1 OLD ORCHARD PLAZA OLD ORCHARD
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City | SKOKIE
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State | IL
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Zip | 60077
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Country | US
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Telephone | 847-763-5882
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Fax | 847-763-5881
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 046-008581
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License Number State | IL
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