Vanessa Ceballos Park, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

13083T Issued in CA

Practice address

375 E Alessandro Blvd
Riverside, CA 92508-2463

Phone

(951) 789-6019

Fax

(951) 789-6036

NPI assigned

Mar 5, 2007

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Vanessa Lebita Ceballos Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Luxottica Retail North America Inc

  dba Sears Optical at Kmart #C1278

  • Eyewear Supplier
  • Riverside, CA
  • NPI 1588752950
  NPD (past)
• Luxottica of America Inc

  dba Lenscrafters #E895

  • Eyewear Supplier
  • Kansas City, MO
  • NPI 1497412522
  NPD (past)

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

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1083743991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28638 QUEENSLAND DR",
            "city": "MENIFEE",
            "state": "CA",
            "postal_code": "925847895",
            "telephone_number": "951-378-8220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 E ALESSANDRO BLVD",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925082463",
            "telephone_number": "951-789-6019",
            "fax_number": "951-789-6036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "VANESSA",
        "middle_name": "CEBALLOS",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-05",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "13083T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VANESSA",
            "last_name": "CEBALLOS",
            "middle_name": "LEBITA",
            "prefix": "DR.",
            "credential": "O.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Kyungsin Park, DDS
• Melissa Park, RN
• Myung Kee Park, DDS
• Nathaniel Park, MD
• Sherie L Park, LMFT
• Wonsok Park, D.C.
• Woojung Park
• Antrinet R Parker
• Curtis Jerome Parker, AMFT
• Desiree Parker

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.