Active NPI
Lori Ann Kucia-Park, O.D.
- Optometrist
- Delano, CA
National Provider Identifier
1407078470
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPT 11801
- Practice address
- 919 13TH Avenue
Delano, CA 93215-2202 - Phone
- (661) 725-3795
- Fax
- (661) 725-3797
- NPI assigned
- May 2, 2007
- 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 |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPT 11801 | CA | Primary |
Addresses
Primary practice location
919 13TH Avenue
Delano, CA 93215-2202
Mailing address
919 13TH Avenue
Delano, CA 93215-2202
Phone (661) 725-3795
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SD0118010 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OPT 11801 | CA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1407078470",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "919 13TH AVENUE",
"city": "DELANO",
"state": "CA",
"postal_code": "932152202",
"telephone_number": "661-725-3795",
"fax_number": "661-725-3797"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "919 13TH AVENUE",
"city": "DELANO",
"state": "CA",
"postal_code": "932152202",
"telephone_number": "661-725-3795",
"fax_number": "661-725-3797"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUCIA-PARK",
"first_name": "LORI",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-02",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "OPT 11801",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "SD0118010",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Delano, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.