Active NPI
Myeyedr Optometry of Indiana, LLC
Doing business as MyEyeDr.
- Optometrist
- Bloomington, IN
National Provider Identifier
1194211581
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- Legal business name
- MYEYEDR OPTOMETRY OF INDIANA, LLC
- Doing business as
- MyEyeDr.
- Practice address
- 101 W Kirkwood Ave
Bloomington, IN 47404 - Phone
- (812) 331-9082
- Fax
- (812) 331-1301
- NPI assigned
- Jul 9, 2018
- Last updated
- May 27, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Sue Healey
- Title
- Secretary
- Phone
- (703) 847-8899
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | Primary |
Addresses
Primary practice location
101 W Kirkwood Ave
Bloomington, IN 47404
Mailing address
8614 Westwood Center Dr FL 9
Vienna, VA 22182-2442
Phone (703) 847-8899
Other names 1
- MyEyeDr.
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190115001215 | IN | Part B Supplier - Clinic/Group Practice | 5496091316 |
Receives reassigned benefits from 157 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
National Provider Directory- Tax ID family
- Myeyedr Optometry of Indiana LLC
Other organizations with this tax ID 49
Organizations that report the same tax identification number in the National Provider Directory.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1531094400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1653609600000",
"number": "1194211581",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8614 WESTWOOD CENTER DR FL 9",
"city": "VIENNA",
"state": "VA",
"postal_code": "221822442",
"telephone_number": "703-847-8899",
"fax_number": "571-223-6780"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 W KIRKWOOD AVE",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "47404",
"telephone_number": "812-331-9082",
"fax_number": "812-331-1301"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MYEYEDR OPTOMETRY OF INDIANA, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2018-07-09",
"last_updated": "2022-05-27",
"certification_date": "2022-05-27",
"status": "A",
"authorized_official_last_name": "HEALEY",
"authorized_official_first_name": "SUE",
"authorized_official_title_or_position": "SECRETARY",
"authorized_official_telephone_number": "703-847-8899"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "MyEyeDr.",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Bloomington, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.