Ellilta Daniel Mezgebu, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

TA2948 Issued in MD

Practice address

2955 Crain Hwy Ste a
Waldorf, MD 20601-2810

Phone

(301) 645-3600

NPI assigned

Sep 13, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD, DC2 enrollments

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 2

Specialty

Optometry

Education

Southern College of Optometry, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Myeyedr Optometry of Maryland LLCGroup PAC ID 6002037629, 121 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Myeyedr Optometry of Maryland, LLC

  • Optometrist
  • Waldorf, MD
  • NPI 1609204437

  MD, Optometrist

  Medicare reassignment Care Compare group NPD
• Myeyedr Optometry of Maryland, LLC

  • Optometrist
  • Clinton, MD
  • NPI 1497124796

  DC

  Medicare reassignment
• Myeyedr Optometry of Maryland, LLC

  • Optometrist
  • Germantown, MD
  • NPI 1225407521
  NPD
• Myeyedr Optometry of Maryland, LLC

  • Optometrist
  • Easton, MD
  • NPI 1386393148
  NPD
• Myeyedr Optometry of Maryland, LLC

  • Optometrist
  • Laurel, MD
  • NPI 1972900058
  NPD

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

{
    "created_epoch": "1694563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706832000000",
    "number": "1548047574",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2955 CRAIN HWY STE A",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206012810",
            "telephone_number": "301-645-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEZGEBU",
        "first_name": "ELLILTA",
        "middle_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-09-13",
        "last_updated": "2024-02-02",
        "certification_date": "2024-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA2948",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Michael J Kuhn DDS PC

• All providers in Waldorf, MD
• Optometrist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 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; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.