Provider Demographics
NPI:1760120265
Name:PARK FAMILY EYECARE INC.
Entity Type:Organization
Organization Name:PARK FAMILY EYECARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-573-9471
Mailing Address - Street 1:2188 ORCHARD MIST ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-1562
Mailing Address - Country:US
Mailing Address - Phone:702-573-9471
Mailing Address - Fax:
Practice Address - Street 1:300 E LAKE MEAD PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-5576
Practice Address - Country:US
Practice Address - Phone:702-861-6657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARK FAMILY EYECARE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty