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15 Division St, New York, NY 10002-6710 | |
(646) 476-5210 | |
(646) 476-5207 |
Full Name | |
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Type | Facility |
Speciality | Technician/technologist |
Location | 15 Division St, New York, New York |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
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1154024768 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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152W00000X | Optometrist | (* (Not Available)) | Secondary |
156F00000X | Technician/technologist | (* (Not Available)) | Primary |
Provider Name | Christy Jooeun Park |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1972225290 PECOS PAC ID: 1759746845 Enrollment ID: I20230425000323 |
Mailing Address | Practice Location Address |
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15 Division St, New York, NY 10002-6710 Ph: (646) 476-5210 | 15 Division St, New York, NY 10002-6710 Ph: (646) 476-5210 |