Individual provider Active NPI

Mackenzie Lane Coyne

  • Optometrist
  • Baltimore, MD
National Provider Identifier
1811799570
Registry record updated Jun 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
TA3064 Issued in MD
Practice address
4940 Eastern Ave
Baltimore, MD 21224-2735
Phone
(410) 550-5568
NPI assigned
Mar 25, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Optometrist 152W00000X TA3064 MD Primary

Addresses

Primary practice location

4940 Eastern Ave
Baltimore, MD 21224-2735

Mailing address

6201 Greenleigh Ave
Middle River, MD 21220-2004

Other practice location 1

4620 Glen Lakes Dr
Powell, OH 43065-8079
Phone (740) 602-3374

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
I20250708004111 MD Practitioner - Optometry 2961916382 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Ohio State University - College of Optometry, 2025
Medicare assignment
May accept Medicare assignment
Group practices
Johns Hopkins UniversityGroup PAC ID 8921903147, 2,886 clinicians

Practice addresses (Care Compare)

1800 Orleans St
Baltimore, MD 21287-0010
Phone (410) 955-5000

4940 Eastern Ave
Baltimore, MD 21224-2735
Phone (410) 550-0100

601 N Caroline St
Baltimore, MD 21287-0006
Phone (410) 955-5080

Hospital & facility affiliations

  • Johns Hopkins Bayview Medical Center Hospital, Baltimore, MD, CCN 210029

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
TA3064MDMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Johns Hopkins University Optometrist CurrentSince Jun 25, 2025 Accepting new patients
Johns Hopkins University CurrentSince Jun 25, 2025 Accepting new patients
Johns Hopkins University Current Accepting new patients

Locations

4940 Eastern Ave
Baltimore, MD 21224

6201 Greenleigh Ave
Middle River, MD 21220
Phone (410) 933-2704

10751 Falls Rd
Timonium, MD 21093
Phone (410) 583-2727

Interoperability endpoints

  • Direct secure messaging: mcoyne1372820@direct.hopkinsmedicine.org

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1742860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750809600000",
    "number": "1811799570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6201 GREENLEIGH AVE",
            "city": "MIDDLE RIVER",
            "state": "MD",
            "postal_code": "212202004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4940 EASTERN AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212242735",
            "telephone_number": "410-550-5568"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4620 Glen Lakes Dr",
            "address_purpose": "LOCATION",
            "city": "Powell",
            "state": "OH",
            "postal_code": "430658079",
            "country_code": "US",
            "telephone_number": "740-602-3374",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COYNE",
        "first_name": "MACKENZIE",
        "middle_name": "LANE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-03-25",
        "last_updated": "2025-06-25",
        "certification_date": "2025-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA3064",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.