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Myeyedr Optometry of Maryland, LLC

Organization Active NPI Optometrist · Lavale, MD

NPI 1306294137 · NPPES record last updated May 27, 2022

Key facts

NPI
1306294137
Entity type
Organization (NPI type 2)
Primary specialty
Optometrist 152W00000X
Legal business name
MYEYEDR OPTOMETRY OF MARYLAND, LLC
Practice address
12101 Winchester Rd Ste 102
Lavale, MD 21502
Phone
(301) 722-6480
Fax
(301) 722-6297
NPI assigned
Jun 2, 2016
Organization subpart
No

Authorized official

Name
Sue Downes
Title
Secretary
Phone
(703) 847-8899

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 125

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 125

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Myeyedr Optometry of Maryland LLC
12101 Winchester Rd, Lavale, MD 21502-7688 · (301) 722-6480		 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignment
Participating since Jul 27, 2014

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in MD

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20141024000821 MD Part B Supplier - Clinic/Group Practice 6002037629 Receives reassigned benefits from 247 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Frederick, MD; Hagerstown, MD; Hanover, MD; Havre de Grace, MD; Hunt Valley, MD; La Plata, MD; Laurel, MD; Lexington Park, MD…
O20210909003848 MD DME Supplier - Physician - Optometrist 6002037629 Practice locations: Lavale, MD

National Provider Directory

Tax ID family
Myeyedr Optometry of MD LLC (71 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist
Group: 193400000X SINGLE SPECIALTY GROUP		 152W00000X Yes

Addresses

Primary practice location

12101 Winchester Rd Ste 102
Lavale, MD 21502

Mailing address

8614 Westwood Center Dr FL 9
Vienna, VA 22182-2442
Phone (703) 847-8899

Other names

  • MyEyeDr. Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 27, 2022.

{
    "created_epoch": "1464825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653609600000",
    "number": "1306294137",
    "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": "12101 WINCHESTER RD STE 102",
            "city": "LAVALE",
            "state": "MD",
            "postal_code": "21502",
            "telephone_number": "301-722-6480",
            "fax_number": "301-722-6297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYEYEDR OPTOMETRY OF MARYLAND, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-02",
        "last_updated": "2022-05-27",
        "certification_date": "2022-05-27",
        "status": "A",
        "authorized_official_last_name": "DOWNES",
        "authorized_official_first_name": "SUE",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "703-847-8899"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  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 Lavale, MD

All providers in Lavale, MD · Optometrist in Maryland

Sources for this page

Verify at the official NPI Registry.