Individual provider Active NPI

Elizabeth C McMunn, O.D.

  • Optometrist
  • Annapolis, MD
National Provider Identifier
1104808930
Registry record updated Mar 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
002594 Issued in CT
Practice address
695 Kinkaid Rd
Annapolis, MD 21402-1006
Phone
(410) 293-4378
NPI assigned
Nov 17, 2005
Last updated
Mar 11, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 002594 CT Primary

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 names 1

  • Dr. Elizabeth Sue Carroll Former name

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20031223000170 CT Practitioner - Optometry 5597663914

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
002594CTMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Nova Southeastern University, Inc Past Accepting new patients
Pape Chiropractic & Wellness Center LLC PastSince Jan 1, 2007 Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1132185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710115200000",
    "number": "1104808930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "695 KINKAID RD",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214021006",
            "telephone_number": "410-293-4378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "695 KINKAID RD",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214021006",
            "telephone_number": "410-293-4378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCMUNN",
        "first_name": "ELIZABETH",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-17",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CT",
            "license": "002594",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "CARROLL",
            "middle_name": "SUE",
            "prefix": "DR.",
            "credential": "OD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Annapolis, MD

Sources for this page

Verify at the official NPI Registry.