Individual provider Active NPI

Jung Ha Park, O.D.

  • Optometrist
  • Middletown, DE
National Provider Identifier
1487843587
Registry record updated Oct 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
I3-0011437 Issued in DE
Practice address
223 E Main St
Middletown, DE 19709-1449
Phone
(302) 376-1900
Fax
(302) 376-5644
NPI assigned
Oct 15, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT002988 GA
Optometrist 152W00000X I3-0011437 DE Primary

Addresses

Primary practice location

223 E Main St
Middletown, DE 19709-1449

Mailing address

8614 Westwood Center Dr FL 9
Vienna, VA 22182-2442
Phone (703) 847-8899

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE
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

Enrollment IDStateProvider typePAC IDDetails
I20220208000526 DE Practitioner - Optometry 9133394448 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Ohio State University - College of Optometry, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Myeyedr. Optometry of Delaware PAGroup PAC ID 1052612009, 27 clinicians

Practice addresses (Care Compare)

223 E Main St
Middletown, DE 19709-1449
Phone (302) 376-1900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
I3-0011437DEMDOptometrist
OPT002988GAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Myeyedr Optometry of Delaware PA Optometrist Current Accepting new patients
Myeyedr Optometry of Delaware PA Optometrist CurrentSince Feb 15, 2022 Accepting new patients
Myeyedr Optometry of Delaware PA Optometrist CurrentSince Feb 15, 2022 Accepting new patients

Locations

1237 Quintilio Dr
Bear, DE 19701
Phone (302) 678-1700

885 S Governors Ave
Dover, DE 19904
Phone (302) 734-5861

223 E Main St
Middletown, DE 19709
Phone (302) 376-1900

4605 Kirkwood Hwy
#A
Wilmington, DE 19808
Phone (302) 999-7171

5601 Concord Pike
Ste C
Wilmington, DE 19803
Phone (302) 600-3927

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

1950 Old Gallows Rd
Ste 520
Vienna, VA 22182

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1192406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728864000000",
    "number": "1487843587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8614 WESTWOOD CENTER DR FL 9",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221822442",
            "telephone_number": "703-847-8899",
            "fax_number": "571-223-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "223 E MAIN ST",
            "city": "MIDDLETOWN",
            "state": "DE",
            "postal_code": "197091449",
            "telephone_number": "302-376-1900",
            "fax_number": "302-376-5644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "JUNG HA",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-15",
        "last_updated": "2024-10-14",
        "certification_date": "2024-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT002988",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "DE",
            "license": "I3-0011437",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Middletown, DE

Sources for this page

Verify at the official NPI Registry.