Individual provider Active NPI

Carmoly T Sanders, O.D.

  • Optometrist
  • Bowie, MD
National Provider Identifier
1164524716
Registry record updated Jan 31, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
TA1639 Issued in MD
Practice address
4412 Mitchellville Rd
Bowie, MD 20716-3112
Phone
(301) 809-0000
Fax
(301) 809-6004
NPI assigned
Sep 3, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X TA1639 MD Primary

Addresses

Primary practice location

4412 Mitchellville Rd
Bowie, MD 20716-3112

Mailing address

1950 Old Gallows Rd Ste 520
Vienna, VA 22182-3970
Phone (703) 847-8899

Other practice location 1

2955 Crain Hwy
Suite A&B
Waldorf, MD 20601-2810
Phone (301) 843-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20111028000480 MD Practitioner - Optometry 2567635097 Reassigns benefits to 1 organization
I20111028000521 DC Practitioner - Optometry 2567635097 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Myeyedr Optometry of Maryland LLCGroup PAC ID 6002037629, 121 clinicians

Practice addresses (Care Compare)

23105 Three Notch Rd
Suite a
California, MD 20619-2417
Phone (301) 863-2020

4412 Mitchellville Rd
Bowie, MD 20716-3112
Phone (301) 809-0000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
TA1639MDMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Myeyedr Optometry of Maryland, LLC Optometrist CurrentSince Sep 30, 2015 Accepting new patients
Myeyedr Optometry of Maryland, LLC Optometrist Current Accepting new patients
Myeyedr Optometry of Maryland, LLC Optometrist CurrentSince Oct 6, 2015 Accepting new patients
Silver Spring Optometry, LLC Optometrist Past Accepting new patients

Locations

2321 Forest Dr
Ste E
Annapolis, MD 21401
Phone (410) 266-3369

6306 York Rd
#1-2
Baltimore, MD 21212
Phone (443) 863-5206

4412 Mitchellville Rd
Bowie, MD 20716
Phone (301) 309-0000

23105 Three Notch Rd
Ste A
California, MD 20619
Phone (301) 863-2020

9131 Piscataway Rd
Ste 120
Clinton, MD 20735
Phone (301) 866-9505

2936 Festival Way
Ste 409A
Waldorf, MD 20601
Phone (301) 710-6919

2955 Crain Hwy
Ste A
Waldorf, MD 20601
Phone (301) 645-3600

1950 Old Gallows Rd
Ste 520
Vienna, VA 22182

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1157241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1517356800000",
    "number": "1164524716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 OLD GALLOWS RD STE 520",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221823970",
            "telephone_number": "703-847-8899",
            "fax_number": "703-991-0514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4412 MITCHELLVILLE RD",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207163112",
            "telephone_number": "301-809-0000",
            "fax_number": "301-809-6004"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2955 Crain Hwy",
            "address_2": "Suite A&B",
            "address_purpose": "LOCATION",
            "city": "Waldorf",
            "state": "MD",
            "postal_code": "206012810",
            "country_code": "US",
            "telephone_number": "301-843-1000",
            "fax_number": "301-843-1919",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANDERS",
        "first_name": "CARMOLY",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-03",
        "last_updated": "2018-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA1639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowie, MD

Sources for this page

Verify at the official NPI Registry.