Active NPI
Agnes Park, MD
- Ophthalmology Physician
- Boston, MA
National Provider Identifier
1124829783
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 207W00000X
- Practice address
- 260 Tremont St
Boston, MA 02116-5603 - Phone
- (617) 636-4600
- NPI assigned
- Mar 20, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 207W00000X | MA | Primary |
Addresses
Primary practice location
260 Tremont St
Boston, MA 02116-5603
Mailing address
39 Heath St Unit 2
Brookline, MA 02445-5909
Phone (857) 389-7124
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250605002924 | MA | Order and Referring Only - Ophthalmology | 3173033586 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 207W00000X | MA | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1742428800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1742428800000",
"number": "1124829783",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "39 HEATH ST UNIT 2",
"city": "BROOKLINE",
"state": "MA",
"postal_code": "024455909",
"telephone_number": "857-389-7124"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "260 TREMONT ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "021165603",
"telephone_number": "617-636-4600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "AGNES",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-03-20",
"last_updated": "2025-03-20",
"certification_date": "2025-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "MA",
"license": "207W00000X",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2025; 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.