Arthur Jinyoung Park, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

33880TLG Issued in CA

Practice address

173 Plaza Dr
Vallejo, CA 94591-3708

Phone

(707) 917-4053

NPI assigned

Feb 9, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Tedder Optometric Corporation, PC

  • Optometrist
  • Lake Forest, CA
  • NPI 1679262158
  Medicare reassignment NPD
• Hansra Optometric Corporation

  • Eyewear Supplier
  • Sacramento, CA
  • NPI 1366258436
  NPD
• National Vision, Inc.

  • Optician
  • Vallejo, CA
  • NPI 1538673587
  NPD (past)

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

{
    "created_epoch": "1518134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1518134400000",
    "number": "1093214561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1241 GOLDEN RAIN RD APT 2L",
            "city": "SEAL BEACH",
            "state": "CA",
            "postal_code": "907403810",
            "telephone_number": "714-336-7055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "173 PLAZA DR",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945913708",
            "telephone_number": "707-917-4053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "ARTHUR",
        "middle_name": "JINYOUNG",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-02-09",
        "last_updated": "2018-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "33880TLG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Frederick Pappas, OPTOMETRIST
• Samantha Paradis
• Paradise Adolescent Homes, Inc.
• Sharina Galamay Paraohao, MT
• Aide Irene Paredes-Salceda, PAC
• Ronald Blake Parker
• Kathrynn Parnow, BCBA, MFTI
• Stephen M. Parodi, MD
• Sylvia Parram
• Sarah Parrish, FNP-BC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.