Stella Jaeyeun Park, O.D

Primary specialty

OptometristTaxonomy code 152W00000X

License

OEG003241 Issued in PA

Practice address

921 Penllyn Blue Bell Pike
Blue Bell, PA 19422-2163

Phone

(215) 628-2020

NPI assigned

Feb 22, 2017

Last updated

Oct 25, 2022By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

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

Pennsylvania College of Optometry, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Provision Eye AssociatesGroup PAC ID 8325303522, 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.

• Provision Eye Associates

  • Optometrist
  • Blue Bell, PA
  • NPI 1326537622
  Medicare reassignment Care Compare group
• Visionworks, Inc.

  dba Visionworks

  • Optometrist
  • Erie, PA
  • NPI 1063579837
  Medicare reassignment NPD
• Visionworks, Inc

  dba Visionworks

  • Eyewear Supplier
  • Simpsonville, SC
  • NPI 1699571166
  NPD

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

{
    "created_epoch": "1487721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666656000000",
    "number": "1457890543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "921 PENLLYN BLUE BELL PIKE",
            "city": "BLUE BELL",
            "state": "PA",
            "postal_code": "194222163",
            "telephone_number": "215-578-7201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "921 PENLLYN BLUE BELL PIKE",
            "city": "BLUE BELL",
            "state": "PA",
            "postal_code": "194222163",
            "telephone_number": "215-628-2020"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "221 Easton Rd Ste 112",
            "address_purpose": "LOCATION",
            "city": "Warrington",
            "state": "PA",
            "postal_code": "189762517",
            "country_code": "US",
            "telephone_number": "215-491-1450",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "167 Montgomery Mall",
            "address_purpose": "LOCATION",
            "city": "North Wales",
            "state": "PA",
            "postal_code": "194543911",
            "country_code": "US",
            "telephone_number": "215-361-8549",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "STELLA",
        "middle_name": "JAEYEUN",
        "name_prefix": "Dr.",
        "credential": "O.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-02-22",
        "last_updated": "2022-10-25",
        "certification_date": "2022-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG003241",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Lynn Otto, LMHC, LPC, NCC, CCMH
• Sara Nicole Pagliaro, DO
• Palmquest Inc.
• In Kook Park, DMD
• Jun Sang Park, D.C
• Aida Pasalic, DMD
• Dipti Patel
• Shreya Patel, CRNP
• Lydia Patselas, LPC
• Matthew Robert Pearson, ATC

• Optometrist in Blue Bell, PA
• Providers in Blue Bell, PA by specialty
• Optometrist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2022; 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.