Provider Demographics
NPI:1235453747
Name:PARK, EUNJOO JULIE (OD)
Entity Type:Individual
Prefix:DR
First Name:EUNJOO
Middle Name:JULIE
Last Name:PARK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 W OLYMPIC BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2484
Mailing Address - Country:US
Mailing Address - Phone:323-735-9286
Mailing Address - Fax:
Practice Address - Street 1:3130 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2484
Practice Address - Country:US
Practice Address - Phone:323-735-9286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11940T152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management