=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710229604
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TONY PARK OD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2013
-----------------------------------------------------
Last Update Date | 01/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6135 JUNCTION BLVD STE A1
-----------------------------------------------------
City | REGO PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11374-2772
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-760-7862
-----------------------------------------------------
Fax | 917-540-3750
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5011 216TH ST
-----------------------------------------------------
City | BAYSIDE HILLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11364-1362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-366-3506
-----------------------------------------------------
Fax | 917-540-3750
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST/OWNER
-----------------------------------------------------
Name | DR. TONY CHAN PARK
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 510-366-3506
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | TUV 007776
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------