STEVE B. PARK, MD PC

Provider Demographics

• NPI: 1235246984
• Name: STEVE B. PARK, MD PC
• Entity Type: Organization
• Organization Name: STEVE B. PARK, MD PC
• Other - Org Name: CORNERSTONE EYE ASSOCIATES
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: OWNER
• Authorized Official - Prefix: DR
• Authorized Official - First Name: STEVE
• Authorized Official - Middle Name: B
• Authorized Official - Last Name: PARK
• Authorized Official - Credentials: MD
• Authorized Official - Phone: 585-328-0153
• Mailing Address - Street 1: 2300 BUFFALO RD
• Mailing Address - Street 2: BLDG 700
• Mailing Address - City: ROCHESTER
• Mailing Address - State: NY
• Mailing Address - Zip Code: 14624-1367
• Mailing Address - Country: US
• Mailing Address - Phone: 585-328-0153
• Mailing Address - Fax: 585-328-0158
• Practice Address - Street 1: 2300 BUFFALO RD
• Practice Address - Street 2: BLDG 700
• Practice Address - City: ROCHESTER
• Practice Address - State: NY
• Practice Address - Zip Code: 14624-1367
• Practice Address - Country: US
• Practice Address - Phone: 585-328-0153
• Practice Address - Fax: 585-328-0158
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-08-25
• Last Update Date: 2019-04-05

Provider Licenses

State	License ID	Taxonomies
NY	TUV004649-1	152W00000X, 152W00000X
NY	T005400-1	152W00000X
NY	TUV003238-1	152W00000X
NY	TUV005295-1	152W00000X
		156FX1800X
NY	182420-1	207W00000X
NY	156287-2	207W00000X
NY	198945-1	207W00000X
NY	083720-1	207W00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	152W00000X	Eye and Vision Services Providers	Optometrist		Group - Single Specialty
No	156FX1800X	Eye and Vision Services Providers	Technician/Technologist	Optician	Group - Single Specialty
No	207W00000X	Allopathic & Osteopathic Physicians	Ophthalmology		Group - Single Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NY	01728156	Medicaid
NY	01093163	Medicaid
NY	01445376	Medicaid
NY	01728156	Medicaid
NY	01445376	Medicaid
NY	0916200002	Medicare NSC
NY	01093163	Medicaid
NY	0916200001	Medicare NSC
NY	T26179	Medicare UPIN
NY	U86718	Medicare UPIN
NY	11217A	Medicare ID - Type Unspecified
NY	U50695	Medicare UPIN
NY	U25116	Medicare UPIN
NY	B72013	Medicare UPIN
NY	G12766	Medicare UPIN
NY	U49432	Medicare UPIN
NY	U42387	Medicare UPIN
NY	H35701	Medicare UPIN
NY	0916200003	Medicare NSC