Active NPI
Myeyedr Optometry of Indiana, LLC
Doing business as MyEyeDr.
- Optometrist
- Bloomington, IN
National Provider Identifier
1437623592
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- Legal business name
- MYEYEDR OPTOMETRY OF INDIANA, LLC
- Doing business as
- MyEyeDr.
- Practice address
- 4719 W State Road 46
Bloomington, IN 47404-9518 - Phone
- (812) 876-2020
- Fax
- (812) 935-2020
- NPI assigned
- Jan 11, 2019
- Last updated
- May 27, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Sue Healey
- Title
- Secretary
- Phone
- (703) 847-8899
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | NU | Primary |
Addresses
Primary practice location
4719 W State Road 46
Bloomington, IN 47404-9518
Mailing address
8614 Westwood Center Dr FL 9
Vienna, VA 22182-2442
Phone (703) 084-7889
Other names 1
- MyEyeDr.
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190115001215 | IN | Part B Supplier - Clinic/Group Practice | 5496091316 |
Receives reassigned benefits from 157 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
National Provider Directory- Tax ID family
- Myfeeyedr Optometry in LLC
Other organizations with this tax ID 49
Organizations that report the same tax identification number in the National Provider Directory.
Locations
4719 W State Road 46
Bloomington, IN 47404
Phone (812) 876-2020
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1547164800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1653609600000",
"number": "1437623592",
"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": "703-084-7889",
"fax_number": "571-223-6780"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4719 W STATE ROAD 46",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474049518",
"telephone_number": "812-876-2020",
"fax_number": "812-935-2020"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MYEYEDR OPTOMETRY OF INDIANA, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2019-01-11",
"last_updated": "2022-05-27",
"certification_date": "2022-05-27",
"status": "A",
"authorized_official_last_name": "HEALEY",
"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"
},
{
"organization_name": "MyEyeDr.",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Bloomington, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2022; 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.