Provider Demographics
NPI:1730306374
Name:PARK, STEVEN J (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:PARK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:395 CASCADE MALL DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-3255
Mailing Address - Country:US
Mailing Address - Phone:360-757-7750
Mailing Address - Fax:360-757-7756
Practice Address - Street 1:395 CASCADE MALL DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-3255
Practice Address - Country:US
Practice Address - Phone:360-757-7750
Practice Address - Fax:360-757-7756
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1983152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1017720Medicaid
WA2019743Medicaid
WA8772PAOtherRBS