Individual
DR. DOROTHY J PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
1818 HAMPTON ST, COLUMBIA, SC 29201-3534
(803) 254-6306
(803) 771-6745
Mailing address
1818 HAMPTON ST, COLUMBIA, SC 29201-3534
(803) 254-6306
(803) 771-6745
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
858
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
57-1062179
BLUE CROSS BLUE SHIELD
SC
05
—
D08588
—
SC
Enumeration date
12/05/2005
Last updated
11/28/2011
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