Jacquelyn Tyra, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

0618002779 Issued in VA

Practice address

43490 Yukon Dr Ste 200
Ashburn, VA 20147-7315

Phone

(703) 724-0330

NPI assigned

Oct 4, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Optometry

Education

University of Missouri St Louis - School of Optometry, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Loudoun Eye Associates, PLLCGroup PAC ID 6709946254, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Loudoun Eye Associates, PLLC

  • Optometrist
  • Ashburn, VA
  • NPI 1811198989
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1538611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684800000000",
    "number": "1154896363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21735 PINEWOOD CT",
            "city": "STERLING",
            "state": "VA",
            "postal_code": "201642300",
            "telephone_number": "703-304-2459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43490 YUKON DR STE 200",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "201477315",
            "telephone_number": "703-724-0330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TYRA",
        "first_name": "JACQUELYN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-10-04",
        "last_updated": "2023-05-23",
        "certification_date": "2023-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618002779",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madhavi Reddy Tummuluri, BT
• Cynthia Schmidt Turner, LCSW, LSATP
• Tneisha Turner
• Sarah Marie Tutolo, NP
• Megan Tychinski
• Tyson Urgent Care, LLC
• Courtney J Ullrich, DMD
• Sital Unadkat
• Tara Lynn Urschel, D.C.
• Adil Usman, M.D.

• Optometrist in Ashburn, VA
• Providers in Ashburn, VA by specialty
• Optometrist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 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.

Verify at the official NPI Registry.