Mark J Park, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT10152T Issued in CA

Practice address

919 13TH Ave
Delano, CA 93215-2202

Phone

(661) 725-3795

Fax

(661) 725-3797

NPI assigned

Jun 9, 2005

Reactivated

Mar 27, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

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 2

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346284800000",
    "number": "1073517801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "919 13TH AVE",
            "city": "DELANO",
            "state": "CA",
            "postal_code": "932152202",
            "telephone_number": "661-725-3795",
            "fax_number": "661-725-3797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "919 13TH AVE",
            "city": "DELANO",
            "state": "CA",
            "postal_code": "932152202",
            "telephone_number": "661-725-3795",
            "fax_number": "661-725-3797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "MARK",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-09",
        "last_updated": "2012-08-30",
        "deactivation_date": "2006-03-21",
        "reactivation_date": "2006-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT10152T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0101520",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrew W. Palmer, CRNA
• Erin Parker Pandol, MPT, OCS
• Paramvir S. Rahal MD, Inc
• Anselmo Bruno Parinas, PT
• Moana Marie Parinas, PTA
• Malcolm Bruce Parker III
• Jufre Pascua
• Verenice Pat, FNP-C
• Patel Pharmacy Inc.
• Vijaykumar B. Patel, M.D.

• Optometrist in Delano, CA
• Providers in Delano, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.