| Tony Park Od Pllc | |
|
6135 Junction Blvd Costco Optometry Rego Park NY 11374-2771 | |
| (718) 760-7862 | |
| (718) 760-7861 |
| Full Name | Tony Park Od Pllc |
|---|---|
| Speciality | Optometrist |
| Location | 6135 Junction Blvd, Rego Park, New York |
| Authorized Official Name and Position | Tony Park (OWNER) |
| Authorized Official Contact | 5103663506 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tony Park Od Pllc 6135 Junction Blvd Costco Optometry Rego Park NY 11374-2771 Ph: (718) 760-7862 | Tony Park Od Pllc 6135 Junction Blvd Costco Optometry Rego Park NY 11374-2771 Ph: (718) 760-7862 |
| NPI Number | 1710229604 |
|---|---|
| Provider Enumeration Date | 03/19/2013 |
| Last Update Date | 04/02/2018 |
| Medicare PECOS PAC ID | 9830331610 |
|---|---|
| Medicare Enrollment ID | O20130807000199 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710229604 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | TUV 007776 (New York) | Secondary |
| 152W00000X | Optometrist | (* (Not Available)) | Primary |
| Provider Name | Tony C Park |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1801942776 PECOS PAC ID: 0345372645 Enrollment ID: I20120411000747 |
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