DR. AMY LEANNE PARK O.D.
NPI 1922333004
Optometrist in Riverside, CA

Q: What is Amy Park's NPI number?

The NPI number for Amy Park is 1922333004. It was assigned to this individual provider in the NPPES registry on October 7, 2009. The provider is also known as Amy Leanne Pedersen.

Q: What is Amy Park's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Q: When was this NPI record last updated?

The NPPES record for Amy Park was last updated on January 11, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since October 07, 2009PECOS EnrolledAccepts Medicare Assignment

10800 MAGNOLIA AVE, RIVERSIDE, CA 92505(951) 353-4701 Get Directions Write a Review

NPPES record last updated: January 11, 2022. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: Jan 11, 2022, Nov 14, 2017 (2 updates tracked since 2017).

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About Dr. Amy Leanne Park O.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. AMY LEANNE PARK O.D. (NPI 1922333004) is an individual optometrist in Riverside, California, licensed in California (14428TLG) and active in the NPI registry since October 2009. She is enrolled in Medicare PECOS and is a graduate of Pacific University - College Of Optometry (2011).

NPPES Registry Identity

NPI1922333004

Entity TypeIndividualFemale

Primary Taxonomy152W00000X

Provider Legal NameDR. AMY LEANNE PARKCredential: O.D.

Location Address10800 MAGNOLIA AVERiverside, CA 92505-3043

Mailing Address10800 Magnolia AveRiverside, CA 92505-3043

Phone(951) 353-4701

Sole ProprietorNo

Medical School CMSPacific University - College Of OptometryGraduated 2011

Enumeration DateOctober 7, 2009

Last NPPES UpdateJanuary 11, 20222 updates tracked since enumeration

✔ NPI 1922333004 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyOptometristEye and Vision Services Providers

Taxonomy Code152W00000X

License✔ Licensed in CA · 14428TLG

Definition

Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

10800 MAGNOLIA AVE, Riverside, CA 92505

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Other Names 1

Other Name (5)Amy Leanne Pedersen

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Amy Leanne Park O.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID3971775495

PECOS Enrollment IDI20130417000515

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

Medicare enrollment records show Amy Park reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Southern California Permanente Medical Group

Same address

Health Maintenance Organization

10800 MAGNOLIA AVE
Riverside, CA 92505

Reassigned Medicare billing, California enrollment
Also billed through NPI 1952333460 (California)
5,228 clinicians in this Medicare group

NPI 1316979834 (866) 984-7483

Permanente Medical Group Inc

348 mi

Internal Medicine

710 LAWRENCE EXPRESSWAY
Santa Clara, CA 95051

Reassigned Medicare billing, California enrollment
20,078 clinicians in this Medicare group

NPI 1073606299 (408) 851-1000

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92505 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$136.04 typical visit price

range $59.60 – $179.42

Typical copayment $34.01 (range $14.90 – $44.85)

Most-billed visit code 99204

Established Patient

$74.08 typical visit price

range $19.37 – $146.42

Typical copayment $18.52 (range $4.84 – $36.60)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KAISER PERMANENTE

General Acute Care Hospital