Active NPI
Jennifer Park
- Optometrist
- Oakland, CA
National Provider Identifier
1467879791
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 14856
- Practice address
- 3060 E 9TH St
Oakland, CA 94601-2905 - Phone
- (510) 535-5500
- NPI assigned
- Mar 25, 2014
- 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 | 14856 | CA | Primary |
Addresses
Primary practice location
3060 E 9TH St
Oakland, CA 94601-2905
Mailing address
2238 Encinal Ave Apt a
Alameda, CA 94501-4425
Phone (510) 415-7501
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1395705600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395705600000",
"number": "1467879791",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2238 ENCINAL AVE APT A",
"city": "ALAMEDA",
"state": "CA",
"postal_code": "945014425",
"telephone_number": "510-415-7501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3060 E 9TH ST",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946012905",
"telephone_number": "510-535-5500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "JENNIFER",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-03-25",
"last_updated": "2014-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "14856",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2014; 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.