Individual provider Active NPI

David Hwantae Park, O.D.

  • Optometrist
  • Irving, TX
National Provider Identifier
1780762245
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
6049TG Issued in TX
Practice address
7750 N Macarthur Blvd
Ste 180
Irving, TX 75063-7524
Phone
(972) 401-0008
Fax
(972) 401-1630
NPI assigned
Nov 1, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 6049TG TX Primary

Addresses

Primary practice location

7750 N Macarthur Blvd
Ste 180
Irving, TX 75063-7524

Mailing address

9100 Bottlebrush LN
Irving, TX 75063-4227
Phone (972) 401-0008

Other identifiers 1

IdentifierTypeStateIssuer
60122914OtherTXDPS REGISTRATION

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6049TGTXMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
2020 Icare and Iwear Irving PLLC Optometrist CurrentSince May 22, 2022 Accepting new patients

Locations

7750 N MacArthur Blvd
Ste 180
Irving, TX 75063
Phone (972) 401-0008

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1780762245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9100 BOTTLEBRUSH LN",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750634227",
            "telephone_number": "972-401-0008",
            "fax_number": "972-401-1630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7750 N MACARTHUR BLVD",
            "address_2": "STE 180",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750637524",
            "telephone_number": "972-401-0008",
            "fax_number": "972-401-1630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "DAVID",
        "middle_name": "HWANTAE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "6049TG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DPS REGISTRATION",
            "identifier": "60122914",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Irving, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.