NPIMap

Organization Active NPI

Myeyedr Optometry of South Carolina, LLC

Doing business as MyEyeDr.

  • Optometrist
  • Summerville, SC
National Provider Identifier
1407730120
Registry record updated Sep 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
MYEYEDR OPTOMETRY OF SOUTH CAROLINA, LLC
Doing business as
MyEyeDr.
Practice address
622 Bacons Bridge Rd Ste B
Summerville, SC 29485-4225
Phone
(843) 594-0919
Fax
(843) 410-5704
NPI assigned
Aug 5, 2025
Last updated
Sep 3, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2025

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
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

622 Bacons Bridge Rd Ste B
Summerville, SC 29485-4225

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 SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140826001090 SC Part B Supplier - Clinic/Group Practice 3173741618 Receives reassigned benefits from 45 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Summerville, SC; Fort Mill, SC; Rock Hill, SC; Pickens, SC; North Charleston, SC; Mt Pleasant, SC; Manning, SC; Indian Land, SC…

Other NPIs on the same Medicare enrollment 16

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 16

National Provider Directory

National Provider Directory
Tax ID family
Myeyedr Optometry South Carolina LLC13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

622 Bacons Bridge Rd
Ste B
Summerville, SC 29485
Phone (843) 594-0919

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1754352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756857600000",
    "number": "1407730120",
    "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": "622 BACONS BRIDGE RD STE B",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294854225",
            "telephone_number": "843-594-0919",
            "fax_number": "843-410-5704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYEYEDR OPTOMETRY OF SOUTH CAROLINA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-08-05",
        "last_updated": "2025-09-03",
        "certification_date": "2025-09-03",
        "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": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MyEyeDr.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Summerville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2025; 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.