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General NPI Number Information
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NPI Number | 1801942776
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Entity Type | Individual
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Provider Name | TONY CHAN PARK OD
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Gender | Male
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 6135 JUNCTION BLVD STE A1
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City | REGO PARK
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State | NY
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Zip | 11374-2772
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Country | US
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Telephone | 718-760-7862
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Fax | 917-540-3750
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Provider Business Mailing Address
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Address Line | 5011 216TH ST
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City | BAYSIDE HILLS
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State | NY
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Zip | 11364-1362
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Country | US
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Telephone | 510-366-3506
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Fax | 917-540-3750
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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 | 007776
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License Number State | NY
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