Individual provider Active NPI

Monica Park

  • Optometrist
  • Reston, VA
National Provider Identifier
1043067572
Registry record updated Sep 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
0618003425 Issued in VA
Practice address
11656 Plaza America Dr
Reston, VA 20190-4700
Phone
(703) 467-9080
NPI assigned
May 2, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 0618003425 VA Primary

Addresses

Primary practice location

11656 Plaza America Dr
Reston, VA 20190-4700

Mailing address

11656 Plaza America Dr
Reston, VA 20190-4700
Phone (703) 467-9080

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240624001313 DC Practitioner - Optometry 6002359635 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northern Virginia Doctors of OptometryGroup PAC ID 1759301765, 21 clinicians

Practice addresses (Care Compare)

11656 Plaza America Dr
Reston, VA 20190-4700
Phone (703) 467-9080

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Virginia Doctors of Optometry Optometrist CurrentSince Jun 10, 2024 Accepting new patients

Locations

1632A Belle View Blvd
Alexandria, VA 22307
Phone (703) 660-9494

1632 Belle View Blvd
#A
Alexandria, VA 22307

7249 Arlington Blvd
Falls Church, VA 22042
Phone (703) 573-1200

11656 Plaza America Dr
Reston, VA 20190
Phone (703) 467-0359

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1714608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726704000000",
    "number": "1043067572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11656 PLAZA AMERICA DR",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201904700",
            "telephone_number": "703-467-9080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11656 PLAZA AMERICA DR",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201904700",
            "telephone_number": "703-467-9080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "MONICA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-02",
        "last_updated": "2024-09-19",
        "certification_date": "2024-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618003425",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Reston, VA

Sources for this page

Verify at the official NPI Registry.