Individual provider Active NPI

Eunice Park, PA-C

  • Medical Physician Assistant
  • Puyallup, WA
National Provider Identifier
1366911604
Registry record updated Jul 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA60920872 Issued in WA
Practice address
1703 S Meridian Ste 101
Puyallup, WA 98371-7590
Phone
(253) 848-3000
Fax
(253) 840-6514
NPI assigned
Nov 15, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1155890 WA
Medical Physician Assistant 363AM0700X PA60920872 WA Primary

Addresses

Primary practice location

1703 S Meridian Ste 101
Puyallup, WA 98371-7590

Mailing address

1703 S Meridian Ste 101
Puyallup, WA 98371-7590
Phone (253) 848-3000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190326000171 WA Practitioner - Physician Assistant 2466792619 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Washington School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cascade Eye and Skin Centers PCGroup PAC ID 4486541554, 47 clinicians

Practice addresses (Care Compare)

11216 Sunrise Blvd E
Suite 3 106
Puyallup, WA 98374-8848
Phone (253) 848-3000

1703 S Meridian
Suite 101
Puyallup, WA 98371-7590
Phone (253) 848-3000

4907 Point Fosdick Dr NW
Suite E700
Gig Harbor, WA 98335-1842
Phone (253) 848-3000

Hospital & facility affiliations

  • Tacoma General Allenmore Hospital Hospital, Tacoma, WA, CCN 500129

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1155890WAMDPhysician Assistant
PA60920872WAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Cascade Eye & Skin Centers P.C. CurrentSince Jun 20, 2023 Accepting new patients

Locations

205 10th St NE
Ste 119
Auburn, WA 98002
Phone (253) 939-7911

4907 Point Fosdick Dr
Ste E700
Gig Harbor, WA 98335

1703 S Meridian
Ste 101
Puyallup, WA 98371
Phone (253) 770-7708

11216 Sunrise Blvd E
Ste 3-102
Puyallup, WA 98374

Organizations & group practices 2

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1542240000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689724800000",
    "number": "1366911604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1703 S MERIDIAN STE 101",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983717590",
            "telephone_number": "253-848-3000",
            "fax_number": "253-840-6514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1703 S MERIDIAN STE 101",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983717590",
            "telephone_number": "253-848-3000",
            "fax_number": "253-840-6514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "EUNICE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-15",
        "last_updated": "2023-07-19",
        "certification_date": "2023-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "1155890",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA60920872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Puyallup, WA

Sources for this page

Verify at the official NPI Registry.