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General NPI Number Information
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NPI Number | 1487864815
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Entity Type | Organization
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Legal Business Name | PARK L HSIEH O D A PROFESSIONAL OPTOMETRIC CORPORATION
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 07/16/2024
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Provider Practice Location Address
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Address Line | 2704 PINOLE VALLEY RD
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City | PINOLE
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State | CA
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Zip | 94564-1425
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Country | US
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Telephone | 510-222-6567
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Fax | 510-222-2161
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Provider Business Mailing Address
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Address Line | 2704 PINOLE VALLEY RD
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City | PINOLE
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State | CA
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Zip | 94564-1425
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Country | US
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Telephone | 510-222-6567
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Fax | 510-222-2161
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PARK LEE HSIEH
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Credential | O.D.
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Telephone | 510-222-6567
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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 | OPT 12680 T
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License Number State | CA
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