MEDICARE: ROMY PARK O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	11541T	CA
2	152W00000X	Optometrist	522	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NV0522	OTHER	NV	EYEMED
2	1215155254	OTHER		EYEMED
3	35421	OTHER	NV	AVESIS
4	1215155254	OTHER		AETNA
5	26488	OTHER	NV	MEDICAL EYE SERVICES
6	56000	OTHER	NV	DAVIS VISION
7	291059	OTHER	NV	NVA
8	26034	OTHER	NV	SPECTERA
9	1215155254	OTHER		UNITED HEALTHCARE

General Provider Information

NPI Number	:	1215155254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROMY PARK O.D.

Provider Business Mailing Address
First Line	:	PO BOX 401240
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89140-1240
Country	:	US
Telephone Number	:	702-641-2007
Fax Number	:	702-258-2006

Provider Business Practice Location Address
First Line	:	3615 S RAINBOW BLVD STE 1
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-1057
Country	:	US
Telephone Number	:	702-641-2007
Fax Number	:	702-258-2006

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	10/28/2024

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Directions to “ ROMY PARK O.D.” Practice Location

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