Provider Demographics
NPI:1013145036
Name:PAK, PETER HYUN (OD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:HYUN
Last Name:PAK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8902 AMPEZO TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-4960
Mailing Address - Country:US
Mailing Address - Phone:512-698-8112
Mailing Address - Fax:
Practice Address - Street 1:11200 LAKELINE MALL DR
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-1501
Practice Address - Country:US
Practice Address - Phone:512-698-8112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7379T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist