Individual provider Active NPI

Michael Wayne Henderson, O.D.

  • Optometrist
  • Charlottesville, VA
National Provider Identifier
1104980341
Registry record updated Jul 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
0618002107 Issued in VA
Practice address
2159 Barracks Rd
Charlottesville, VA 22903-4812
Phone
(434) 977-2020
Fax
(434) 977-4842
NPI assigned
Dec 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 0618002107 VA Primary

Addresses

Primary practice location

2159 Barracks Rd
Charlottesville, VA 22903-4812

Mailing address

2159 Barracks Rd
Charlottesville, VA 22903-4812
Phone (434) 977-2020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20120413000220 VA Practitioner - Optometry 0345342481 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Myeyedr Optometry of Virginia, PLLCGroup PAC ID 0143448456, 133 clinicians

Practice addresses (Care Compare)

2159 Barracks Rd
Charlottesville, VA 22903-4812
Phone (434) 977-2020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4605MAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Myeyedr Optometry of Virginia, PLLC Optometrist CurrentSince Apr 29, 2019 Accepting new patients
Myeyedr Optometry of Virginia, PLLC Optometrist CurrentSince Apr 29, 2019 Accepting new patients
Myeyedr Optometry of Virginia PLLC Optometrist Current Accepting new patients

Locations

44727 Brimfield Dr
Ashburn, VA 20147
Phone (571) 385-4600

213 Connor Dr
Charlottesville, VA 22911
Phone (434) 975-2020

2159 Barracks Rd
Charlottesvle, VA 22903
Phone (434) 944-2020

1950 Old Gallows Rd
Ste 520
Vienna, VA 22182

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405296000000",
    "number": "1104980341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2159 BARRACKS RD",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229034812",
            "telephone_number": "434-977-2020",
            "fax_number": "434-977-4842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2159 BARRACKS RD",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229034812",
            "telephone_number": "434-977-2020",
            "fax_number": "434-977-4842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "MICHAEL",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-21",
        "last_updated": "2014-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618002107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlottesville, VA

Sources for this page

Verify at the official NPI Registry.