MEDICARE: DR. ADELPHY PAYERO OD

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	OPT003699	GA
2	152W00000X	Optometrist	OPC6918	FL

General Provider Information

NPI Number	:	1831906569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADELPHY PAYERO OD

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	:	105 GRAND CENTRAL BLVD STE 110
Second Line	:
City	:	POOLER
State	:	GA
Zip	:	31322-4148
Country	:	US
Telephone Number	:	912-450-9200
Fax Number	:	912-450-9201

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2024
Last Update Date	:	04/29/2026

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Directions to “ DR. ADELPHY PAYERO OD” Practice Location

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