Provider Demographics
NPI:1508536293
Name:PARK, ERIKA SEOYEON (OD)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:SEOYEON
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 1:40 HARRISON ST APT 667
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-3875
Mailing Address - Country:US
Mailing Address - Phone:512-529-7606
Mailing Address - Fax:
Practice Address - Street 1:117 PELTON CENTER WAY
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4815
Practice Address - Country:US
Practice Address - Phone:510-895-2116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34998152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist