Organization
WILLIAM L PARK, OD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM L PARK OD (MEMBER)
(316) 440-1690
Entity
Organization
Contact information
Practice address
610 N MAIN ST, SUITE 201, WICHITA, KS 67203-3601
(316) 440-1690
(316) 440-1695
Mailing address
610 N MAIN ST, SUITE 201, WICHITA, KS 67203-3601
(316) 440-1690
(316) 440-1695
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1798
KS
152WL0500X
Low Vision Rehabilitation Optometrist
1798
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
KA1156
MEDICARE PTAN
KS
Enumeration date
07/22/2008
Last updated
04/14/2011
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