Provider Demographics
NPI:1417097171
Name:PARK-CHANG, JULIE S (OD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:S
Last Name:PARK-CHANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4388 E CRAIG RD STE 150
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-1962
Mailing Address - Country:US
Mailing Address - Phone:702-643-9191
Mailing Address - Fax:702-643-8191
Practice Address - Street 1:4388 E CRAIG RD STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-1962
Practice Address - Country:US
Practice Address - Phone:702-643-9191
Practice Address - Fax:702-643-8191
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV401152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist