Jenny Y Park, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

14361 Issued in CA

Practice address

30606 Santa Margarita Pkwy Ste A103
Rancho Santa Margarita, CA 92688-4500

Phone

(949) 658-2670

NPI assigned

Oct 16, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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.

• Tedder Optometric Corporation, PC

  • Optometrist
  • Lake Forest, CA
  • NPI 1679262158
  Medicare reassignment NPD
• Hansra Optometric Corporation

  • Eyewear Supplier
  • Rancho Santa Margarita, CA
  • NPI 1275232266
  NPD
• Hansra Optometric Corporation

  • Eyewear Supplier
  • Sacramento, CA
  • NPI 1366258436
  NPD

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

{
    "created_epoch": "1224115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718755200000",
    "number": "1669624052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30606 SANTA MARGARITA PKWY STE A103",
            "city": "RANCHO SANTA MARGARITA",
            "state": "CA",
            "postal_code": "926884500",
            "telephone_number": "949-658-2670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30606 SANTA MARGARITA PKWY STE A103",
            "city": "RANCHO SANTA MARGARITA",
            "state": "CA",
            "postal_code": "926884500",
            "telephone_number": "949-658-2670"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9500 S Western Ave",
            "address_2": "EVERGREEN PLAZA #G3A",
            "address_purpose": "LOCATION",
            "city": "Evergreen Park",
            "state": "IL",
            "postal_code": "608052856",
            "country_code": "US",
            "telephone_number": "708-425-5285",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "JENNY",
        "middle_name": "Y",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-16",
        "last_updated": "2024-06-19",
        "certification_date": "2024-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046010147",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "14361",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rena Alexa Palmer, PA-C
• Pan Patel
• Tiffany Lynn Panick, P.T.
• Parajon Dental Group Inc
• Carlos J Parajon, DDS
• Anika Rajesh Patel, PHARMD
• Deepak Patel, MD
• Pankaj Patel, R.PH
• Paul a Day DDS a Professional Dental Corporation
• Bonnie Sue Payne

• Optometrist in Rancho Santa Margarita, CA
• Providers in Rancho Santa Margarita, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2024; 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.