Tiffany Koon, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

TA2446 Issued in MD

Practice address

1127 MD RT 3 N # 104
Gambrills, MD 21054-1715

Phone

(410) 988-2662

Fax

(410) 988-4553

NPI assigned

Jun 7, 2013

Last updated

Aug 12, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

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

Specialty

Optometry

Education

New England College of Optometry, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Panoptic Eye Care LLCGroup PAC ID 2163755653, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: t.koonod@direct.revolutionehr.com

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

• Panoptic Eye Care, LLC

  • Optometrist
  • Gambrills, MD
  • NPI 1972087591
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1370563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565568000000",
    "number": "1760820054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1127 MD RT 3 N # 104",
            "city": "GAMBRILLS",
            "state": "MD",
            "postal_code": "210541715",
            "telephone_number": "410-988-2662",
            "fax_number": "410-988-4553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1127 MD RT 3 N # 104",
            "city": "GAMBRILLS",
            "state": "MD",
            "postal_code": "210541715",
            "telephone_number": "410-988-2662",
            "fax_number": "410-988-4553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOON",
        "first_name": "TIFFANY",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-07",
        "last_updated": "2019-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV007964-1",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA2446",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "T.KoonOD@direct.revolutionehr.com",
            "affiliation": "N",
            "endpointDescription": "EHR email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1127 Md Rt 3 N # 104",
            "city": "Gambrills",
            "state": "MD",
            "country_code": "US",
            "postal_code": "210541715",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Youngeun Kim
• Kimberly S Wallace MD LLC
• Joseph D Kling, D.C.
• Karen H Klocko, D.D.S
• Lee Koch, PT
• Kovach Chiropractic and Wellness Center PA
• Alicia Marie Kovach, D.C.
• Mary Deffley Kurfess, PHD, MSSW
• Laura Kelly Nutrition, LLC (Apeiron Wellness)
• Laura Lynch NP Telehealth Services

• Optometrist in Gambrills, MD
• Providers in Gambrills, MD by specialty
• Optometrist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2019; 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.