NPIMap

Organization Active NPI

Canton Crossing Optometry, LLC

  • Optometrist
  • Baltimore, MD
National Provider Identifier
1326474263
Registry record updated May 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
CANTON CROSSING OPTOMETRY, LLC
Practice address
3715 Boston St
Baltimore, MD 21224-5752
Phone
(443) 839-0335
Fax
(443) 839-0336
NPI assigned
Sep 24, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 2, 2024

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

3715 Boston St
Baltimore, MD 21224-5752

Mailing address

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

Other names 1

  • MyEyeDr Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140206000731 MD Part B Supplier - Clinic/Group Practice 4284863614 Receives reassigned benefits from 33 practitioners
Practice locations: Baltimore, MD

National Provider Directory

National Provider Directory

Locations

3715 Boston St
Baltimore, MD 21224
Phone (443) 839-0335

Practitioners & affiliated clinicians

Practitioners 35

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

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1379980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714608000000",
    "number": "1326474263",
    "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": "3715 BOSTON ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212245752",
            "telephone_number": "443-839-0335",
            "fax_number": "443-839-0336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANTON CROSSING OPTOMETRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-24",
        "last_updated": "2024-05-02",
        "certification_date": "2024-05-02",
        "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"
        },
        {
            "organization_name": "MyEyeDr",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2024; 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.

Verify at the official NPI Registry.