Individual provider Active NPI

Jaclyn Elizabeth Coyner, OD

  • Optometrist
  • Annapolis, MD
National Provider Identifier
1265928071
Registry record updated Jul 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
TA2637 Issued in MD
Practice address
1505 Annapolis Mall
Annapolis, MD 21401-3090
Phone
(410) 573-2095
NPI assigned
Jul 4, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 4, 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 TA2637 MD Primary

Addresses

Primary practice location

1505 Annapolis Mall
Annapolis, MD 21401-3090

Mailing address

1505 Annapolis Mall
Annapolis, MD 21401-3090
Phone (410) 573-2095

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
I20230124000588 MD Practitioner - Optometry 9638540073 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eye Care Associates of Maryland LLCGroup PAC ID 1850491994, 22 clinicians

Practice addresses (Care Compare)

1748 Merritt Blvd
Dundalk, MD 21222-3212
Phone (443) 530-6381

3755 Old Court Rd E
Levin Eye Care
Pikesville, MD 21208-3918
Phone (410) 486-1010

454A Ritchie Hwy
Severna Park, MD 21146-2911
Phone (410) 486-1010

8109 Harford Rd
Suite G
Parkville, MD 21234-9205
Phone (410) 486-1010

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Eye Care Associates of MD, LLC Optometrist CurrentSince Nov 1, 2022 Accepting new patients

Locations

8109 Harford Rd
Ste G
Parkville, MD 21234

454C Governor Ritchie Hwy
Severna Park, MD 21146
Phone (410) 305-0888

920 Providence Rd
Ste 100
Towson, MD 21286
Phone (443) 394-8679

Interoperability endpoints

  • Direct secure messaging: jaclyn.coyner.p1@direct.levineyecare.nextgenshare.com

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1530662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530662400000",
    "number": "1265928071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1505 ANNAPOLIS MALL",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214013090",
            "telephone_number": "410-573-2095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 ANNAPOLIS MALL",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214013090",
            "telephone_number": "410-573-2095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COYNER",
        "first_name": "JACLYN",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-04",
        "last_updated": "2018-07-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA2637",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Annapolis, MD

Sources for this page

Verify at the official NPI Registry.