Active NPI
Tracy Tom Park, O.D.
- Optometrist
- Garden Grove, CA
National Provider Identifier
1770896011
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 14009
- Practice address
- 12302 Garden Grove Blvd
Suite 6
Garden Grove, CA 92843-1802 - Phone
- (714) 590-2020
- Fax
- (714) 590-2044
- NPI assigned
- Jul 15, 2010
- Sex
- Female
- Sole proprietor
- Yes
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 | 14009 | CA | Primary |
Addresses
Primary practice location
12302 Garden Grove Blvd
Suite 6
Garden Grove, CA 92843-1802
Mailing address
12302 Garden Grove Blvd
Suite 6
Garden Grove, CA 92843-1802
Phone (714) 590-2020
Other names 1
- Ms. Tracy Mee Lin Tom
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100928001628 | CA | Practitioner - Optometry | 8921124819 | Practice locations: Garden Grove, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14009 | CA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tracy Tom Park, O.D. | Optometrist | Past | Accepting new patients |
| Luxottica of America Inc. | Past | Accepting new patients | |
| Luxottica of America Inc | Past | Accepting new patients |
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": "1279152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402272000000",
"number": "1770896011",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12302 GARDEN GROVE BLVD",
"address_2": "SUITE 6",
"city": "GARDEN GROVE",
"state": "CA",
"postal_code": "928431802",
"telephone_number": "714-590-2020",
"fax_number": "714-590-2044"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12302 GARDEN GROVE BLVD",
"address_2": "SUITE 6",
"city": "GARDEN GROVE",
"state": "CA",
"postal_code": "928431802",
"telephone_number": "714-590-2020",
"fax_number": "714-590-2044"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "TRACY",
"middle_name": "TOM",
"name_prefix": "Mrs.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-07-15",
"last_updated": "2014-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "14009",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "TRACY",
"last_name": "TOM",
"middle_name": "MEE LIN",
"prefix": "MS.",
"credential": "O.D.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Garden Grove, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 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.