Provider Demographics
NPI:1306000120
Name:PARK, INN JEE (OD)
Entity Type:Individual
Prefix:
First Name:INN
Middle Name:JEE
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 1:2921 ERIE BLVD E
Mailing Address - Street 2:MASS OPTOMETRIC ASSOCIATES, P.C.
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224-1430
Mailing Address - Country:US
Mailing Address - Phone:315-446-3145
Mailing Address - Fax:315-445-7675
Practice Address - Street 1:1 HIGHLAND AVE # 3B
Practice Address - Street 2:MASS OPTOMETRIC ASSOCIATES, P.C.
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-6603
Practice Address - Country:US
Practice Address - Phone:781-321-9039
Practice Address - Fax:781-321-8611
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003516A152W00000X
MA4686152W00000X
NH0819152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist