Robin Mevissen, OD
Individual provider Active NPI Optometrist · Poolesville, MD
NPI 1164500864 · NPPES record last updated Jul 26, 2011
Key facts
- NPI
- 1164500864
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- TA1222 (MD)
- Practice address
- 20005 B Fisher Ave
Poolesville, MD 20837 - Phone
- (301) 916-3214
- Fax
- (301) 916-3101
- NPI assigned
- Nov 1, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in DC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110421000439 | DC | Practitioner - Optometry | 5092819045 |
Reassigns benefits to 1 organization Practice locations: Poolesville, MD |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0618000326 | VA | MD | Optometrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | TA1222 | MD | Yes |
| Optometrist | 152W00000X | 0618000326 | VA |
Addresses
Primary practice location
20005 B Fisher Ave
Poolesville, MD 20837
Mailing address
19739 Selby Ave
Poolesville, MD 20837-2408
Phone (301) 916-3214
Other providers in Poolesville, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 26, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.