Provider Demographics
NPI:1457664591
Name:PAK, DO J (OD)
Entity Type:Individual
Prefix:
First Name:DO
Middle Name:J
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 1:3001 S MICHIGAN AVE
Mailing Address - Street 2:APT 308
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-3261
Mailing Address - Country:US
Mailing Address - Phone:312-622-8968
Mailing Address - Fax:
Practice Address - Street 1:3333 W TOUHY AVE
Practice Address - Street 2:LINCOLNWOOD TOWN CTR
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-2721
Practice Address - Country:US
Practice Address - Phone:847-675-8637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010380152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist