Provider Demographics
NPI:1528411261
Name:PAEK, HELEN (OD)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:
Last Name:PAEK
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 1:193 IRIS RD
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-1214
Mailing Address - Country:US
Mailing Address - Phone:510-912-1821
Mailing Address - Fax:
Practice Address - Street 1:193 IRIS RD
Practice Address - Street 2:
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-1214
Practice Address - Country:US
Practice Address - Phone:510-912-1821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT33500 - TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist