Organization Active NPI

Tony Park OD PLLC

  • Optometrist
  • Rego Park, NY
National Provider Identifier
1710229604
Registry record updated Jan 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
TONY PARK OD PLLC
Practice address
6135 Junction Blvd Ste A1
Rego Park, NY 11374-2772
Phone
(718) 760-7862
Fax
(917) 540-3750
NPI assigned
Mar 19, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2026

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

Authorized official

Name
Dr. Tony Chan Park, ODNPI 1801942776
Title
Optometrist/Owner
Phone
(510) 366-3506

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary
Clinic/Center 261Q00000X TUV 007776 NY

Addresses

Primary practice location

6135 Junction Blvd Ste A1
Rego Park, NY 11374-2772

Mailing address

5011 216TH St
Bayside Hills, NY 11364-1362
Phone (510) 366-3506

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130807000199 NY Part B Supplier - Clinic/Group Practice 9830331610 Receives reassigned benefits from 1 practitioner
Practice locations: Rego Park, NY

National Provider Directory

National Provider Directory

Locations

6135 Junction Blvd
Ste A1
Rego Park, NY 11374
Phone (718) 760-7862

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1363651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768867200000",
    "number": "1710229604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5011 216TH ST",
            "city": "BAYSIDE HILLS",
            "state": "NY",
            "postal_code": "113641362",
            "telephone_number": "510-366-3506",
            "fax_number": "917-540-3750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6135 JUNCTION BLVD STE A1",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113742772",
            "telephone_number": "718-760-7862",
            "fax_number": "917-540-3750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TONY PARK OD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-19",
        "last_updated": "2026-01-20",
        "certification_date": "2026-01-20",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "TONY",
        "authorized_official_middle_name": "CHAN",
        "authorized_official_title_or_position": "OPTOMETRIST/OWNER",
        "authorized_official_telephone_number": "510-366-3506",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NY",
            "license": "TUV 007776",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rego Park, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.