Active NPI
Susan Ly, DR.
- Optometrist
- Chantilly, VA
National Provider Identifier
1154686889
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 0618002157
- Practice address
- 14391 Chantilly Crossing LN
Chantilly, VA 20151-2118 - Phone
- (703) 817-0748
- Fax
- (703) 817-0748
- NPI assigned
- Jul 9, 2012
- Last updated
- Feb 22, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | TA2308 | MD | |
| Optometrist | 152W00000X | 0618002157 | VA | Primary |
Addresses
Primary practice location
14391 Chantilly Crossing LN
Chantilly, VA 20151-2118
Mailing address
12527 Cerromar PL
Fairfax, VA 22030-6653
Phone (703) 338-8444
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- International American University at Puerto Rico - School of Optometry, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
14391 Chantilly Crossing LN
Chantilly, VA 20151-2118
Phone (703) 817-0748
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TA2308 | MD | MD | Optometrist |
Organizations & group practices 1
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": "1341792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1677024000000",
"number": "1154686889",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12527 CERROMAR PL",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220306653",
"telephone_number": "703-338-8444",
"fax_number": "703-817-0748"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14391 CHANTILLY CROSSING LN",
"city": "CHANTILLY",
"state": "VA",
"postal_code": "201512118",
"telephone_number": "703-817-0748",
"fax_number": "703-817-0748"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LY",
"first_name": "SUSAN",
"credential": "DR.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-07-09",
"last_updated": "2023-02-22",
"certification_date": "2023-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MD",
"license": "TA2308",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "VA",
"license": "0618002157",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chantilly, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.