Provider Demographics
NPI:1073896460
Name:PARK OPTOMETRIC INCORPORATED
Entity Type:Organization
Organization Name:PARK OPTOMETRIC INCORPORATED
Other - Org Name:EYECARE CRISP VISION OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:SETHI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:831-375-3937
Mailing Address - Street 1:2440 FREMONT ST STE 209
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-6850
Mailing Address - Country:US
Mailing Address - Phone:831-375-3937
Mailing Address - Fax:866-585-6553
Practice Address - Street 1:2440 FREMONT ST STE 209
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-6850
Practice Address - Country:US
Practice Address - Phone:831-375-3937
Practice Address - Fax:866-585-6553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-22
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10808T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGS353AMedicare PIN