Elizabeth C McMunn, O.D.
Individual provider
Active NPI
Optometrist · Annapolis, MD
NPI 1104808930 · NPPES record last updated Mar 11, 2024
Key facts
- NPI
- 1104808930
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 002594 (CT)
- Practice address
- 695 Kinkaid Rd
Annapolis, MD 21402-1006
- Phone
- (410) 293-4378
- NPI assigned
- Nov 17, 2005
- Sex
- Female
- Sole proprietor
- No
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 and National Provider Directory roles.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|
| I20031223000170 |
CT |
Practitioner - Optometry |
5597663914 |
|
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|
| 2594 | CT | MD | Professional Counselor |
| 002594 | CT | MD | Occupational Therapist |
Practice roles
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|
| Optometrist |
152W00000X |
002594 |
CT |
Yes |
Addresses
Primary practice location
695 Kinkaid Rd
Annapolis, MD 21402-1006
Mailing address
695 Kinkaid Rd
Annapolis, MD 21402-1006
Phone (410) 293-4378
Other identifiers
| Identifier | Type | State | Issuer |
|---|
| 090002594CT01 | Other | CT | ANTHEM PROVIDER NUMBER |
| 2584969 | Other | CT | UNITED |
| 7280400 | Other | CT | AETNA PROVIDER NUMBER |
| P3655173 | Other | CT | OXFORD |
| 025940 | Other | CT | CONNECTICARE PROVIDER NUM |
| 205205873 | Other | CT | TRICARE |
| 2447250 | Other | CT | CIGNA |
Other names
- Dr. Elizabeth Sue Carroll Former name