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General NPI Number Information
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NPI Number | 1730239559
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Entity Type | Individual
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Provider Name | PARK LEE HSIEH O.D.
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Gender | Male
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 02/02/2023
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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 |
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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 | OPT 12680 TLG
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License Number State | CA
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