Individual provider Active NPI

Maria Bernadette Nunez-Imholtz, OD

  • Optometrist
  • Waldorf, MD
National Provider Identifier
1760420418
Registry record updated Oct 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
TA1917 Issued in MD
Practice address
2955 Crain Hwy Ste a&B
Waldorf, MD 20601-2810
Phone
(301) 645-3600
Fax
(301) 870-9415
NPI assigned
Jun 3, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X TA1917 MD Primary

Addresses

Primary practice location

2955 Crain Hwy Ste a&B
Waldorf, MD 20601-2810

Mailing address

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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 1

Enrollment IDStateProvider typePAC IDDetails
I20060927000179 MD Practitioner - Optometry 4587669429 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pennsylvania College of Optometry, 2004
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)

2955 Crain Hwy
Ab
Waldorf, MD 20601-2810
Phone (301) 645-3600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Myeyedr Optometry of Maryland, LLC Optometrist CurrentSince Apr 16, 2018 Accepting new patients
Myeyedr Optometry of Maryland, LLC Optometrist CurrentSince Apr 16, 2018 Accepting new patients
Myeyedr Optometry of Maryland, LLC Optometrist Current Accepting new patients
Silver Spring Optometry, LLC Optometrist Past Accepting new patients

Locations

22610 Newcut Rd
Ste E4A
Clarksburg, MD 20871
Phone (301) 874-5777

10264 Southern Md Blvd
Ste 101
Dunkirk, MD 20754
Phone (410) 257-6931

1700 Kingfisher Dr
Ste 9
Frederick, MD 21701
Phone (301) 874-5777

3540 Sugarloaf Pkwy
Ste D04
Urbana, MD 21704
Phone (301) 871-5777

2955 Crain Hwy
Ste A
Waldorf, MD 20601
Phone (301) 645-3600

2936 Festival Way
Ste 409A
Waldorf, MD 20601
Phone (301) 710-6919

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

1950 Old Gallows Rd
Ste 520
Vienna, VA 22182

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728518400000",
    "number": "1760420418",
    "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&B",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206012810",
            "telephone_number": "301-645-3600",
            "fax_number": "301-870-9415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NUNEZ-IMHOLTZ",
        "first_name": "MARIA",
        "middle_name": "BERNADETTE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-03",
        "last_updated": "2024-10-10",
        "certification_date": "2024-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA1917",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waldorf, MD

Sources for this page

Verify at the official NPI Registry.