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Myeyedr Optometry of North Carolina PLLC

Organization Active NPI Optometrist · Wilmington, NC

NPI 1104874353 · NPPES record last updated May 29, 2022

Key facts

NPI
1104874353
Entity type
Organization (NPI type 2)
Primary specialty
Optometrist 152W00000X
Legal business name
MYEYEDR OPTOMETRY OF NORTH CAROLINA PLLC
Practice address
201 Racine Dr
Wilmington, NC 28403-8702
Phone
(910) 395-6050
Fax
(910) 794-2222
NPI assigned
May 4, 2006
Organization subpart
No

Authorized official

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

Other NPIs with the same Medicare PAC ID 17

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

Corporate family (same tax ID) 16

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 167

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

View all 167

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2299272Myeyedr Optometry of North Carolina, PLLC
201 Racine Dr, Wilmington, NC 28403		Certificate of waiverFeb 15, 2028

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Myeyedr Optometry of North Carolina
201 Racine Dr, Wilmington, NC 28403-8702 · (910) 395-6050		 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignment
Participating since Jul 31, 2013

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in NC

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20130904000726 NC Part B Supplier - Clinic/Group Practice 6608019096 Receives reassigned benefits from 258 practitioners
This NPI is an additional NPI on the enrollment
O20140731000797 NC DME Supplier - Physician - Optometrist 6608019096 Practice locations: Wilmington, NC

National Provider Directory

Tax ID family
Myeyedr Optometry of North Carolina PLLC (55 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist
Group: 193400000X SINGLE SPECIALTY GROUP		 152W00000X Yes

Addresses

Primary practice location

201 Racine Dr
Wilmington, NC 28403-8702

Mailing address

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

Other identifiers

IdentifierTypeStateIssuer
410032676OtherNCTG RRMCR
410032674OtherNCCG RRMCR
0204HOtherNCBCBS GRP #
890204HMedicaidNC
410049393OtherNCKC RRMCR
CD6765OtherNCRR MEDICARE GROUP #

Other names

  • MyEyeDr Doing business as

Other providers in Wilmington, NC

All providers in Wilmington, NC · Optometrist in North Carolina

Sources for this page

Verify at the official NPI Registry.