Individual provider Active NPI

Sean Matthew Skierczynski, O.D.

  • Optometrist
  • Arden, NC
National Provider Identifier
1194958025
Registry record updated Nov 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2175 Issued in NC
Practice address
2145 Hendersonville Rd
Suite D
Arden, NC 28704-9723
Phone
(828) 681-8000
Fax
(828) 681-0990
NPI assigned
Aug 26, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2175 NC Primary

Addresses

Primary practice location

2145 Hendersonville Rd
Suite D
Arden, NC 28704-9723

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
5915546MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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

Enrollment IDStateProvider typePAC IDDetails
I20100908000952 NC Practitioner - Optometry 2769507177 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Myeyedr Optometry of North Carolina PLLCGroup PAC ID 6608019096, 167 clinicians

Practice addresses (Care Compare)

2145 Hendersonville Rd
Suite D
Arden, NC 28704-9724
Phone (828) 681-8000

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery17

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2175NCMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Myeyedr Optometry of North Carolina, PLLC Optometrist Current Accepting new patients
Myeyedr Optometry of North Carolina, PLLC Optometrist CurrentSince Nov 30, 2020 Accepting new patients
Mission Hospitals Inc Current Accepting new patients
Myeyedr Optometry of North Carolina, PLLC Optometrist CurrentSince Nov 30, 2020 Accepting new patients
Myeyedr Optometry of North Carolina Optometrist Past Accepting new patients

Locations

2145 Hendersonville Rd
Ste D
Arden, NC 28704
Phone (828) 681-8000

1960 Randolph Rd
Charlotte, NC 28207
Phone (704) 372-5332

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

1950 Old Gallows Rd
Ste 520
Vienna, VA 22182

Organizations & group practices 5

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": "1251244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605139200000",
    "number": "1194958025",
    "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": "571-223-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2145 HENDERSONVILLE RD",
            "address_2": "SUITE D",
            "city": "ARDEN",
            "state": "NC",
            "postal_code": "287049723",
            "telephone_number": "828-681-8000",
            "fax_number": "828-681-0990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SKIERCZYNSKI",
        "first_name": "SEAN",
        "middle_name": "MATTHEW",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-26",
        "last_updated": "2020-11-12",
        "certification_date": "2020-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NC",
            "license": "2175",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5915546",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Arden, NC

Sources for this page

Verify at the official NPI Registry.