Poolesville Vision and Contact Lens Service

Primary specialty

OptometristTaxonomy code 152W00000X

License

TA1222 Issued in MD

Legal business name

POOLESVILLE VISION AND CONTACT LENS SERVICE

Doing business as

Poolesville Vision Service

Practice address

20005 B Fisher Ave
Poolesville, MD 20837-2408

Phone

(301) 916-3214

Fax

(301) 916-3101

NPI assigned

Aug 10, 2011

Last updated

Aug 9, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Robin Mevissen, O.D.NPI 1164500864

Title

Owner

Phone

(310) 916-3214

Specialties & licenses 7

Addresses

Other names 1

• Poolesville Vision Service Doing business as

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

Locations

Practitioners 2

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.

• Robin Mevissen, OD

  • Optometrist
  • Poolesville, MD
  • NPI 1164500864

  DC

  Medicare reassignment Authorized official
• Thomas K. McInnes, O.D.

  • Optometrist
  • Silver Spring, MD
  • NPI 1447312061

  DC

  Medicare reassignment

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

{
    "created_epoch": "1312934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533772800000",
    "number": "1114206943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20005 B FISHER AVE",
            "city": "POOLESVILLE",
            "state": "MD",
            "postal_code": "208372408",
            "telephone_number": "301-916-3214",
            "fax_number": "301-916-3101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20005 B FISHER AVE",
            "city": "POOLESVILLE",
            "state": "MD",
            "postal_code": "208372408",
            "telephone_number": "301-916-3214",
            "fax_number": "301-916-3101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POOLESVILLE VISION AND CONTACT LENS SERVICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-10",
        "last_updated": "2018-08-09",
        "status": "A",
        "authorized_official_last_name": "MEVISSEN",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-916-3214",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA1222",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "MD",
            "license": "TA1222",
            "primary": false
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "MD",
            "license": "TA1222",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "MD",
            "license": "TA1222",
            "primary": false
        },
        {
            "code": "152WS0006X",
            "taxonomy_group": "",
            "desc": "Optometrist, Sports Vision",
            "state": "MD",
            "license": "TA1222",
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "MD",
            "license": "TA1222",
            "primary": false
        },
        {
            "code": "152WX0102X",
            "taxonomy_group": "",
            "desc": "Optometrist, Occupational Vision",
            "state": "MD",
            "license": "TA1222",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Poolesville Vision Service",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nurturing Minds Healthcare Services LLC
• Sarah Merie Paksima, MPH, MBA, CD (DONA)
• Emily E Pavlick, LCSW-C
• Poolesville Family Practice LLC
• Poolesville Physical Therapy
• Possible Rays Wellness, LLC
• Emma Ridgway, M.S.W.
• Danielle Marie Roche, LCSW-C
• Erica Salpino
• Samuel Wilson Cooper LLC (True Nature Healing and Wellness)

• Optometrist in Poolesville, MD
• Providers in Poolesville, MD by specialty
• Optometrist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.