Provider Demographics
NPI:1487864815
Name:PARK L. HSIEH, O.D., A PROFESSIONAL OPTOMETRIC CORPORATION
Entity Type:Organization
Organization Name:PARK L. HSIEH, O.D., A PROFESSIONAL OPTOMETRIC CORPORATION
Other - Org Name:EYE LOVE OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PARK
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HSIEH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:510-222-6567
Mailing Address - Street 1:2704 PINOLE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-1425
Mailing Address - Country:US
Mailing Address - Phone:510-222-6567
Mailing Address - Fax:510-222-2161
Practice Address - Street 1:2704 PINOLE VALLEY RD
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-1425
Practice Address - Country:US
Practice Address - Phone:510-222-6567
Practice Address - Fax:510-222-2161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 12680 T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4475038Medicaid
CADP0855OtherMEDICARE RAILROAD
CADP0855Medicare PIN
CA4475038Medicaid
CAV03146Medicare UPIN