Provider Demographics
NPI:1841254216
Name:LEE PARK, HANNAH JIYOUNG (OD)
Entity type:Individual
Prefix:DR
First Name:HANNAH
Middle Name:JIYOUNG
Last Name:LEE PARK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:JIYOUNG
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2921 ERIE BLVD E
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224-1430
Mailing Address - Country:US
Mailing Address - Phone:315-445-7465
Mailing Address - Fax:315-445-7675
Practice Address - Street 1:1004 OLD COUNTRY RD
Practice Address - Street 2:DAVIS VISION
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4917
Practice Address - Country:US
Practice Address - Phone:516-681-1161
Practice Address - Fax:516-942-7582
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYUUT0065221152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U91906Medicare UPIN
C215G1Medicare ID - Type Unspecified