Roy Edward Park, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

0618001310 Issued in VA

Practice address

43480 Yukon Dr
Suite 214
Ashburn, VA 20147-6984

Phone

(703) 724-0330

Fax

(703) 724-0811

NPI assigned

Sep 12, 2006

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

Enrolled in VA

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

Specialty

Optometry

Education

Pennsylvania College of Optometry, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Loudoun Eye Associates, PLLCGroup PAC ID 6709946254, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Loudoun Eye Associates, PLLC

  • Optometrist
  • Ashburn, VA
  • NPI 1811198989
  Medicare reassignment Care Compare group NPD Authorized official
• Doctors on Sight, Optometrists, Inc.

  • Optometrist
  • Waldorf, MD
  • NPI 1700801339
  NPD (past)

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

{
    "created_epoch": "1158019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303171200000",
    "number": "1861596447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43480 YUKON DR",
            "address_2": "SUITE 214",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "201476988",
            "telephone_number": "703-724-0330",
            "fax_number": "703-724-0811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43480 YUKON DR",
            "address_2": "SUITE 214",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "201476984",
            "telephone_number": "703-724-0330",
            "fax_number": "703-724-0811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "ROY",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-12",
        "last_updated": "2011-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618001310",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010272815",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nikolaos Papageorgiou, DDS
• Paradigm Shift LLC
• Daniel Paris, PSY.D.
• Carolyn Park
• Kyung Wook Park, DDS
• Stephanie Park, PHARM D
• Jenna Parker, LMSW
• Chad Parsons, D.C.
• Ashley Passarelli, CCC-SLP
• Passport Health Holdings, LLC

• Optometrist in Ashburn, VA
• Providers in Ashburn, VA by specialty
• Optometrist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2011; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.