Provider Demographics
NPI:1124678925
Name:PARK, EUNICE
Entity type:Individual
Prefix:
First Name:EUNICE
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6771 BEACH BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-3470
Mailing Address - Country:US
Mailing Address - Phone:213-925-4754
Mailing Address - Fax:
Practice Address - Street 1:6771 BEACH BLVD STE B
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-3470
Practice Address - Country:US
Practice Address - Phone:213-925-4754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier