Individual
CONNIE M. PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1425 S EUCLID ST, FULLERTON, CA 92832-3153
(714) 680-5000
(714) 680-5821
Mailing address
1425 S EUCLID ST, FULLERTON, CA 92832-3153
(714) 680-5000
(714) 680-5821
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
CA OPT 9747
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SD097470
—
CA
Enumeration date
10/13/2006
Last updated
07/08/2007
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