Individual provider Active NPI

Laice Lanette Jeffries, O.D.

  • Optometrist
  • California, MD
National Provider Identifier
1215032461
Registry record updated Nov 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
TA1454 Issued in MD
Practice address
23105 Three Notch Rd Ste a
California, MD 20619-2417
Phone
(301) 863-2020
Fax
(301) 863-2417
NPI assigned
Sep 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X TA1454 MD Primary

Addresses

Primary practice location

23105 Three Notch Rd Ste a
California, MD 20619-2417

Mailing address

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

Other practice location 1

29015 Three Notch Rd
Mechanicsville, MD 20659-3228
Phone (301) 884-4774

Other identifiers 2

IdentifierTypeStateIssuer
25101OtherMDSPECTERA
36787OtherMDAVESIS

Other names 1

  • Dr. Laice Lanette Quick Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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
I20100617000614 MD Practitioner - Optometry 3779613724 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Medicine and Surgery, 1996
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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Myeyedr Optometry of Maryland, LLC Optometrist CurrentSince Aug 6, 2018 Accepting new patients
Myeyedr Optometry of Maryland, LLC Optometrist CurrentSince Aug 6, 2018 Accepting new patients
Myeyedr Optometry of Maryland, LLC Optometrist Current Accepting new patients
Silver Spring Optometry, LLC Optometrist Past Accepting new patients

Locations

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

10264 Southern Md Blvd
Ste 101
Dunkirk, MD 20754
Phone (410) 257-6931

46300 Lexington Village Way
Ste 105
Lexington Park, MD 20653
Phone (301) 862-2436

29015 Three Notch Rd
Unit 6
Mechanicsvlle, MD 20659
Phone (301) 884-4774

130 W Dares Beach Rd
Prnc Frederck, MD 20678
Phone (410) 535-2020

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

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

1950 Old Gallows Rd
Ste 520
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": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698883200000",
    "number": "1215032461",
    "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": "866-795-4020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23105 THREE NOTCH RD STE A",
            "city": "CALIFORNIA",
            "state": "MD",
            "postal_code": "206192417",
            "telephone_number": "301-863-2020",
            "fax_number": "301-863-2417"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "29015 Three Notch Rd",
            "address_purpose": "LOCATION",
            "city": "Mechanicsville",
            "state": "MD",
            "postal_code": "206593228",
            "country_code": "US",
            "telephone_number": "301-884-4774",
            "fax_number": "301-884-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JEFFRIES",
        "first_name": "LAICE",
        "middle_name": "LANETTE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-13",
        "last_updated": "2023-11-02",
        "certification_date": "2023-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA1454",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPECTERA",
            "identifier": "25101",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVESIS",
            "identifier": "36787",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAICE",
            "last_name": "QUICK",
            "middle_name": "LANETTE",
            "prefix": "DR.",
            "credential": "O.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in California, MD

Sources for this page

Verify at the official NPI Registry.