Park, Mark J
Park, Mark J is an sole proprietor health care provider with primary practice located at 919 13Th Ave , Delano CA 93215-2202. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Park, Mark J can be contacted via phone (661) 725-3795.Contact Information
Primary practice address
919 13Th Ave
Delano CA 93215-2202
Phone: (661) 725-3795
Fax: (661) 725-3797
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | OPT10152T | California |
Profile Details
| NPI number | 1073517801 |
|---|---|
| LBN Legal business name | Park, Mark J |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 9th, 2005 |
| Last updated | Aug 30th, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1073517801 | NPPES |
| California | MEDICAID | SD0101520 |
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