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General NPI Number Information
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NPI Number | 1508302944
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Entity Type | Organization
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Legal Business Name | VISTAPARK FAMILY OPTOMETRY PC
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Dates
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Enumeration Date | 01/09/2017
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Last Update Date | 01/09/2017
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Provider Practice Location Address
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Address Line | 428 W CAPITOL EXPY
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City | SAN JOSE
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State | CA
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Zip | 95136-1303
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Country | US
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Telephone | 408-578-6181
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Fax | 408-578-0617
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Provider Business Mailing Address
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Address Line | 428 W CAPITOL EXPY
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City | SAN JOSE
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State | CA
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Zip | 95136-1303
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Country | US
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Telephone | 408-578-6181
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Fax | 408-578-0617
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Authorized Official
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Title or Position | CEO
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Name | YUN SANG PARK
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Credential | O.D.
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Telephone | 408-578-6181
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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 | 10154T
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License Number State | CA
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