NPIMap

Organization Active NPI

Myeyedr Optometry of Indiana, LLC

Doing business as MyEyeDr.

  • Optometrist
  • Fort Wayne, IN
National Provider Identifier
1962998393
Registry record updated May 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
MYEYEDR OPTOMETRY OF INDIANA, LLC
Doing business as
MyEyeDr.
Practice address
3401 Lake Ave
Fort Wayne, IN 46805-5500
Phone
(260) 426-3095
Fax
(260) 420-2258
NPI assigned
Jul 9, 2018
Last updated
May 27, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2022

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

Authorized official

Name
Sue Downs
Title
Secretary
Phone
(703) 847-8899

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

3401 Lake Ave
Fort Wayne, IN 46805-5500

Mailing address

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

Other names 1

  • MyEyeDr. Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190115001215 IN Part B Supplier - Clinic/Group Practice 5496091316 Receives reassigned benefits from 157 practitioners
This NPI is an additional NPI on the enrollment
O20240626003837 IN DME Supplier - Physician - Optometrist 5496091316 Practice locations: Fort Wayne, IN

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Myeyedr Optometry of Indiana, LLC3401 Lake Ave, Fort Wayne, IN 46805-5500(260) 426-3095 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Nov 19, 2018

National Provider Directory

National Provider Directory
Tax ID family
Myeyedr Optometry of Indiana LLC50 organizations share this tax ID, including this one

Other organizations with this tax ID 49

Organizations that report the same tax identification number in the National Provider Directory.

View all 49

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1531094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653609600000",
    "number": "1962998393",
    "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",
            "fax_number": "571-223-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 LAKE AVE",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468055500",
            "telephone_number": "260-426-3095",
            "fax_number": "260-420-2258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYEYEDR OPTOMETRY OF INDIANA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-09",
        "last_updated": "2022-05-27",
        "certification_date": "2022-05-27",
        "status": "A",
        "authorized_official_last_name": "DOWNS",
        "authorized_official_first_name": "SUE",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "703-847-8899"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MyEyeDr.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.