Individual
OK PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
D0050879
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
406613800 404589100
—
MD
01
—
767APA 68609505
CAREFIRST
MD
01
—
DD8163 P00253267
RAILROAD MEDICARE
GA
01
—
J727 0001
CAREFIRST
DC
Enumeration date
07/11/2006
Last updated
03/25/2026
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