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Individual

LESLIE PARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1258 6TH AVE, NEW YORK, NY 10020-1511
(646) 789-4843
Mailing address
24047 69TH AVE, DOUGLASTON, NY 11362-1943
(646) 472-9816

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
009878
NY

Other

Enumeration date
08/04/2023
Last updated
08/04/2023
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