David L Park, O.D., M.S.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT7782T Issued in CA

Practice address

102 Scott St
Ukiah, CA 95482-4316

Phone

(707) 462-7040

Fax

(707) 462-7089

NPI assigned

Sep 30, 2005

Last updated

Mar 15, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

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.

• Gilbreath & Park Optometry Inc

  • Optometrist
  • Ukiah, CA
  • NPI 1245422310
  NPD (past)

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

{
    "created_epoch": "1128038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1331769600000",
    "number": "1558358937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 SCOTT ST",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954824316",
            "telephone_number": "707-462-7040",
            "fax_number": "707-462-7089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 SCOTT ST",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954824316",
            "telephone_number": "707-462-7040",
            "fax_number": "707-462-7089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "DAVID",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "O.D., M.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-30",
        "last_updated": "2012-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT7782T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0077820",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christina Palomo
• Amanda Theresa Pantaleon, LMFT
• Victor Pantaleon
• Lorraine R Pantic, LMFT
• Carol Lowenheim Park, LMFT
• Sarah Park
• Megan Elliott Parker
• Amber Parkinson
• Krishna Parmar
• Rebekah Parsons

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.