Provider Demographics
NPI:1356524748
Name:PARK OPTICAL INC
Entity type:Organization
Organization Name:PARK OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRE
Authorized Official - Prefix:MR
Authorized Official - First Name:MOIN
Authorized Official - Middle Name:
Authorized Official - Last Name:UDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-778-4516
Mailing Address - Street 1:524 CLARKSON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2015
Mailing Address - Country:US
Mailing Address - Phone:718-778-4516
Mailing Address - Fax:718-774-5636
Practice Address - Street 1:524 CLARKSON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2015
Practice Address - Country:US
Practice Address - Phone:718-778-4516
Practice Address - Fax:718-774-5636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-09
Last Update Date:2007-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006359-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty