Tracy Tom Park, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

14009 Issued in CA

Legal business name

TRACY TOM PARK, O.D.

Doing business as

Pacific Optometry Group

Practice address

12302 Garden Grove Blvd Ste 6
Garden Grove, CA 92843-1802

Phone

(808) 222-6218

Fax

(714) 590-2044

NPI assigned

Jun 18, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Tracy Tom Park, ODNPI 1770896011

Title

Owner

Phone

(714) 590-2020

Specialties & licenses 1

Addresses

Other names 1

• Pacific Optometry Group Doing business as

Practitioners 1

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

• Tracy Tom Park, O.D.

  • Optometrist
  • Garden Grove, CA
  • NPI 1770896011
  NPD (past) Authorized official

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

{
    "created_epoch": "1529280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529280000000",
    "number": "1912491598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12302 GARDEN GROVE BLVD STE 6",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928431802",
            "telephone_number": "808-222-6218",
            "fax_number": "714-590-2044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12302 GARDEN GROVE BLVD STE 6",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928431802",
            "telephone_number": "808-222-6218",
            "fax_number": "714-590-2044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRACY TOM PARK, O.D.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-18",
        "last_updated": "2018-06-18",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "TOM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "714-590-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "14009",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pacific Optometry Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Adrian Totanes
• Randall Lesley Tovar-Pratt
• Lianna Minette Towers
• Mia Isabella Traches Nunez
• Tracy Nguyen, D.D.S., Professional Dental Corp.
• Tram Pham Pharmd, Inc (Lam Pharmacy)
• Anh Thu Tram, D.D.S.
• Melissa Thuy Tram, DDS
• Thinh Tram
• Tran Pharmacy

• Optometrist in Garden Grove, CA
• Providers in Garden Grove, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2018; 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.