Provider Demographics
NPI:1396393385
Name:LISA PARK OD PLLC
Entity Type:Organization
Organization Name:LISA PARK OD PLLC
Other - Org Name:FOCAL POINT EYECARE INSTITUTE OF MYOPIA MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-325-2022
Mailing Address - Street 1:1428 W HEBRON PKWY STE 125
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-6345
Mailing Address - Country:US
Mailing Address - Phone:972-325-2022
Mailing Address - Fax:972-332-0308
Practice Address - Street 1:1428 W HEBRON PKWY STE 125
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-6345
Practice Address - Country:US
Practice Address - Phone:972-325-2022
Practice Address - Fax:972-332-0308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-03
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty