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NPI Code Detail

MEDICARE: MYEYEDR OPTOMETRY OF OHIO, LLC

MEDICARE: MYEYEDR OPTOMETRY OF OHIO, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist

General Provider Information

NPI Number : 1215596721
Entity Type Code : Organization
Provider Name (Legal Business Name) : MYEYEDR OPTOMETRY OF OHIO, LLC
Provider Business Mailing Address
First Line : 8614 WESTWOOD CENTER DR FL 9
Second Line :
City : VIENNA
State : VA
Zip : 22182-2442
Country : US
Telephone Number : 703-847-8899
Fax Number : 571-223-6780
Provider Business Practice Location Address
First Line : 5305 GLENWAY AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45238-3706
Country : US
Telephone Number : 513-521-9461
Fax Number : 513-347-0078
Authorized Official
Title or Position : SECRETARY
Name : SUE DOWNES
Credential :
Telephone Number : 703-847-8899
Provider Enumeration Date : 06/08/2019
Last Update Date : 05/25/2022

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