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General NPI Number Information
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NPI Number | 1841402385
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Entity Type | Organization
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Legal Business Name | ROMY PARK OD PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 3615 S RAINBOW BLVD STE 1
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City | LAS VEGAS
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State | NV
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Zip | 89103-1057
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Country | US
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Telephone | 702-641-2007
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Fax | 702-258-2006
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Provider Business Mailing Address
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Address Line | PO BOX 401240
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City | LAS VEGAS
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State | NV
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Zip | 89140-1240
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROMY PARK
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Credential | O.D.
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Telephone | 702-641-2007
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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 | 522
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License Number State | NV
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