Provider Demographics
NPI:1730239559
Name:HSIEH, PARK LEE (OD)
Entity type:Individual
Prefix:DR
First Name:PARK
Middle Name:LEE
Last Name:HSIEH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2704 PINOLE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-1425
Mailing Address - Country:US
Mailing Address - Phone:510-222-6567
Mailing Address - Fax:510-222-2161
Practice Address - Street 1:2704 PINOLE VALLEY RD
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-1425
Practice Address - Country:US
Practice Address - Phone:510-222-6567
Practice Address - Fax:510-222-2161
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 12680 TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4475038Medicaid
CA4475038Medicaid
CASD0126803Medicare PIN