Individual provider Active NPI

Mark Elliott Maybury, OD

  • Optometrist
  • Aurora, CO
National Provider Identifier
1811091812
Registry record updated Dec 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT.0001100 Issued in CO
Practice address
6750 S Cornerstar Way
Suite E
Aurora, CO 80016-1573
Phone
(303) 693-1853
Fax
(303) 693-3664
NPI assigned
Sep 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 45324RTSL CO
Optometrist 152W00000X OPT.0001100 CO Primary

Addresses

Primary practice location

6750 S Cornerstar Way
Suite E
Aurora, CO 80016-1573

Mailing address

1950 Old Gallows Rd Ste 520
Vienna, VA 22182-3970
Phone (703) 847-8899

Other identifiers 1

IdentifierTypeStateIssuer
08011009MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20080306000095 CO Practitioner - Optometry 2860577533 Reassigns benefits to 1 organization
Practice locations: Aurora, CO

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Myeyedr Optometry of Colorado PCGroup PAC ID 7113359415, 58 clinicians

Practice addresses (Care Compare)

6750 S Cornerstar Way
Suite E
Aurora, CO 80016-1573
Phone (303) 693-1853

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

LicenseStateTypeSpecialty
45324RTSLCOMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Myeyedr Optometry of Colorado PC Optometrist CurrentSince Dec 7, 2020 Accepting new patients
Myeyedr Optometry of Colorado PC Optometrist CurrentSince Dec 7, 2020 Accepting new patients
Myeyedr Optometry of Colorado PC Optometrist Current Accepting new patients

Locations

6750 S Cornerstar Way
Ste E
Aurora, CO 80016
Phone (303) 693-1853

200 W County Line Rd
Ste 150
Highlands Ranch, CO 80129
Phone (303) 794-2433

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

1950 Old Gallows Rd
Ste 520
Vienna, VA 22182

Interoperability endpoints

  • Direct secure messaging: mmaybury019160@myeyedr.emadirect.md

Organizations & group practices 3

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": "1157932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606780800000",
    "number": "1811091812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 OLD GALLOWS RD STE 520",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221823970",
            "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": "6750 S CORNERSTAR WAY",
            "address_2": "SUITE E",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800161573",
            "telephone_number": "303-693-1853",
            "fax_number": "303-693-3664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYBURY",
        "first_name": "MARK",
        "middle_name": "ELLIOTT",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-11",
        "last_updated": "2020-12-01",
        "certification_date": "2020-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CO",
            "license": "45324RTSL",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CO",
            "license": "OPT.0001100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08011009",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Aurora, CO

Sources for this page

Verify at the official NPI Registry.