Provider Demographics
NPI:1063696730
Name:PARK, ESTHER C (OD)
Entity type:Individual
Prefix:
First Name:ESTHER
Middle Name:C
Last Name:PARK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 LAKEWOOD CENTER MALL
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-2417
Mailing Address - Country:US
Mailing Address - Phone:562-634-2442
Mailing Address - Fax:
Practice Address - Street 1:63 LAKEWOOD CENTER MALL
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2417
Practice Address - Country:US
Practice Address - Phone:562-634-2442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13266152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist