Provider Demographics
NPI:1558487462
Name:PARK, WILLIAM HOWARD (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:HOWARD
Last Name:PARK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Mailing Address - Street 1:47001 PALA RD
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-2925
Mailing Address - Country:US
Mailing Address - Phone:951-676-6810
Mailing Address - Fax:951-225-6873
Practice Address - Street 1:47001 PALA RD
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-2925
Practice Address - Country:US
Practice Address - Phone:951-676-6810
Practice Address - Fax:951-225-6873
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13082T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU99178Medicare UPIN