Inn Jee Park, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

4686 Issued in MA

Practice address

1 Highland Ave # 3B
Mass Optometric Associates, P.C.
Malden, MA 02148-6603

Phone

(781) 321-9039

Fax

(781) 321-8611

NPI assigned

Jul 10, 2008

Last updated

Oct 10, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1215648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1223596800000",
    "number": "1306000120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2921 ERIE BLVD E",
            "address_2": "MASS OPTOMETRIC ASSOCIATES, P.C.",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132241430",
            "telephone_number": "315-446-3145",
            "fax_number": "315-445-7675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 HIGHLAND AVE # 3B",
            "address_2": "MASS OPTOMETRIC ASSOCIATES, P.C.",
            "city": "MALDEN",
            "state": "MA",
            "postal_code": "021486603",
            "telephone_number": "781-321-9039",
            "fax_number": "781-321-8611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "INN",
        "middle_name": "JEE",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-10",
        "last_updated": "2008-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18003516A",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MA",
            "license": "4686",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NH",
            "license": "0819",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amiesha S Panchal, MD
• Elizabeth Grace Pandiscio, LCSW
• Nathan Pardue
• Ann Ursula Parisi, PT
• Parisian Style Beauty Supplies & Braids, LLC
• Tobey Hinden Parker Geller
• Nava Parvaneh
• Tulsi Patel, MD
• Liliana Patino
• Mitchell Patino

• Optometrist in Malden, MA
• Providers in Malden, MA by specialty
• Optometrist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2008; 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.