Brian Edward Wong Park, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

15075 Issued in CA

Practice address

1695 Arden Way
Sacramento, CA 95815-4004

Phone

(916) 564-5983

NPI assigned

Sep 2, 2014

Last updated

Sep 2, 2014By the provider in NPPES

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

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

Specialty

Optometry

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Greenhaven OptometryGroup PAC ID 2769628460, 2 clinicians

Practice addresses (Care Compare)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Greenhaven Optometry

  • Corneal and Contact Management Optometrist
  • Sacramento, CA
  • NPI 1639426273
  Medicare reassignment Care Compare group NPD
• Norman Lee Takeda, O.D.

  • Optometrist
  • Sacramento, CA
  • NPI 1558339077
  Medicare reassignment
• Dr. Norman Takeda

  • Optometrist
  • Sacramento, CA
  • NPI 1518141928
  NPD (past)
• Usv Optical Inc.

  • Eyewear Supplier
  • Sacramento, CA
  • NPI 1710908975
  NPD (past)

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

{
    "created_epoch": "1409616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409616000000",
    "number": "1164822714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7116 SHERICE CT",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958313041",
            "telephone_number": "916-607-2833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1695 ARDEN WAY",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958154004",
            "telephone_number": "916-564-5983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "BRIAN EDWARD",
        "middle_name": "WONG",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-09-02",
        "last_updated": "2014-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "15075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caitlin Marie Parish
• Daniel Parish, DDS
• Park Sacramento Assisted Living LLC
• Eun Young Park-Stauber
• Brian Duke Park, M.D.
• Carey Park, ASW
• Chan H. Park, MD
• David Todd Park Jr.
• Diane Daeun Park
• Ellen Park, O.D.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2014; 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.