NPIMap

Organization Active NPI

Myeyedr Optometry of Indiana, LLC

Doing business as MyEyeDr.

  • Optometrist
  • Lebanon, IN
National Provider Identifier
1083100424
Registry record updated May 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
MYEYEDR OPTOMETRY OF INDIANA, LLC
Doing business as
MyEyeDr.
Practice address
2705 N Lebanon St Ste 230
Lebanon, IN 46052-8627
Phone
(765) 482-2066
Fax
(765) 482-4847
NPI assigned
Jul 9, 2018
Last updated
May 27, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2022

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

Authorized official

Name
Sue Downs
Title
Secretary
Phone
(703) 847-8899

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

2705 N Lebanon St Ste 230
Lebanon, IN 46052-8627

Mailing address

8614 Westwood Center Dr FL 9
Vienna, VA 22182-2442
Phone (703) 847-8899

Other names 1

  • MyEyeDr. Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190115001215 IN Part B Supplier - Clinic/Group Practice 5496091316 Receives reassigned benefits from 157 practitioners

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
15D2303289Myeyedr Optometry of Indiana, LLC2705 N Lebanon St, Ste 230, Lebanon, IN 46052Certificate of waiverApr 22, 2028

National Provider Directory

National Provider Directory

Locations

1921 E 53rd St
Anderson, IN 46013
Phone (765) 649-2278

3965 W 106th St
Ste 120
Carmel, IN 46032
Phone (317) 602-6332

1130 Washington St
Columbus, IN 47201
Phone (812) 379-9893

11720 Olio Rd
Fishers, IN 46037
Phone (317) 570-2778

7840 E 96th St
Fishers, IN 46037
Phone (317) 595-9999

4335 E 82nd St
Ste 105
Indianapolis, IN 46250
Phone (317) 284-9148

6985 W 38th St
Indianapolis, IN 46254
Phone (317) 243-0028

422 Perry St
La Porte, IN 46350
Phone (219) 325-0404

17151 Mercantile Blvd
Ste 100
Noblesville, IN 46060
Phone (317) 259-4234

1501 W Oak St
Zionsville, IN 46077

Practitioners & affiliated clinicians

Practitioners 163

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 163

NPI Registry JSON

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

{
    "created_epoch": "1531094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653609600000",
    "number": "1083100424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8614 WESTWOOD CENTER DR FL 9",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221822442",
            "telephone_number": "703-847-8899",
            "fax_number": "571-223-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2705 N LEBANON ST STE 230",
            "city": "LEBANON",
            "state": "IN",
            "postal_code": "460528627",
            "telephone_number": "765-482-2066",
            "fax_number": "765-482-4847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYEYEDR OPTOMETRY OF INDIANA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-09",
        "last_updated": "2022-05-27",
        "certification_date": "2022-05-27",
        "status": "A",
        "authorized_official_last_name": "DOWNS",
        "authorized_official_first_name": "SUE",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "703-847-8899"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MyEyeDr.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lebanon, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.