Connie M. Park, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

CA OPT 9747 Issued in CA

Practice address

1425 S Euclid St
Fullerton, CA 92832-3153

Phone

(714) 680-5000

Fax

(714) 680-5821

NPI assigned

Oct 13, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

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 and National Provider Directory roles.

• New World Optometric Center

  • Optometrist
  • Fullerton, CA
  • NPI 1144497710
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1437249190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1425 S EUCLID ST",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928323153",
            "telephone_number": "714-680-5000",
            "fax_number": "714-680-5821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 S EUCLID ST",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928323153",
            "telephone_number": "714-680-5000",
            "fax_number": "714-680-5821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "CONNIE",
        "middle_name": "M.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "CA OPT 9747",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD097470",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Utsavi Mukesh Parikh, PTA
• Alice Park
• Bruce S Park, MD
• Chanjoon Park, LAC
• Cliff Jaebum Park
• David J Park, M.D.
• Eugene Park, L.AC.
• Gene Hyounglin Park, D.D.S., M.S.
• Heejin Park
• Jaeyong Park, LAC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.

Verify at the official NPI Registry.