MEDICARE: MYEYEDR OPTOMETRY OF NORTH CAROLINA, PLLC

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
1	152W00000X	Optometrist	1043	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	2468327	OTHER	NC	MEDICARE GROUP NO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295792364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MYEYEDR OPTOMETRY OF NORTH CAROLINA, PLLC

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	:	1003 VANDORA SPRINGS RD
Second Line	:
City	:	GARNER
State	:	NC
Zip	:	27529-3545
Country	:	US
Telephone Number	:	919-772-4575
Fax Number	:	919-772-4911

Authorized Official
Title or Position	:	SECRETARY
Name	:	MRS. SUE HEALEY
Credential	:	OD
Telephone Number	:	703-847-8899

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	05/29/2022

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