Robin Mevissen, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

TA1222 Issued in MD

Practice address

20005 B Fisher Ave
Poolesville, MD 20837

Phone

(301) 916-3214

Fax

(301) 916-3101

NPI assigned

Nov 1, 2006

Last updated

Jul 26, 2011By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Poolesville Vision and Contact Lens Service

  dba Poolesville Vision Service

  • Optometrist
  • Poolesville, MD
  • NPI 1114206943

  DC

  Medicare reassignment Authorized official

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311638400000",
    "number": "1164500864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19739 SELBY 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": "20837",
            "telephone_number": "301-916-3214",
            "fax_number": "301-916-3101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEVISSEN",
        "first_name": "ROBIN",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2011-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA1222",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618000326",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Mahoney, LCPC
• Robert Maletta
• Maryland CVS Pharmacy, L.L.C. (CVS Pharmacy # 01797)
• Stephanie Lynn McKenney Groff, DO
• MD Sleep Solutions LLC
• Nurturing Minds Healthcare Services LLC
• Sarah Merie Paksima, MPH, MBA, CD (DONA)
• Emily E Pavlick, LCSW-C
• Poolesville Family Practice LLC
• Poolesville Physical Therapy

• 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 Jul 26, 2011; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.