{
"Npi": {
"NPI": "1710229604",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TONY PARK OD PLLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5011 216TH ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BAYSIDE HILLS",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11364-1362",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "510-366-3506",
"MailingAddressFaxNumber": "917-540-3750",
"FirstLinePracticeLocationAddress": "6135 JUNCTION BLVD STE A1",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "REGO PARK",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11374-2772",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "718-760-7862",
"PracticeLocationAddressFaxNumber": "917-540-3750",
"EnumerationDate": "03/19/2013",
"LastUpdateDate": "01/15/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PARK",
"AuthorizedOfficialFirstName": "TONY",
"AuthorizedOfficialMiddleName": "CHAN",
"AuthorizedOfficialTitle": "OPTOMETRIST/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "OD",
"AuthorizedOfficialTelephoneNumber": "510-366-3506",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "TUV 007776",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}