Provider Demographics
NPI:1316021462
Name:MYEYEDR OPTOMETRY OF NORTH CAROLINA, PLLC
Entity Type:Organization
Organization Name:MYEYEDR OPTOMETRY OF NORTH CAROLINA, PLLC
Other - Org Name:MYEYEDR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEALEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-847-8899
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:584 CHURCH ST N
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4573
Practice Address - Country:US
Practice Address - Phone:704-782-0677
Practice Address - Fax:704-262-9772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2022-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1849152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC37-1457054OtherCIGNA
NC16745OtherSPECTERA
NC2200491OtherUHC
NC37-1457054OtherPCHS
NC37-1457054OtherSUPERIOR VISION
NC89093MHMedicaid
NC2120312OtherMAMSI
NC37-1457054OtherHCS
NCNC1849OtherEYEMED/ECPA
NC017AAOtherBCBS
NC37-1457054OtherFHN
NC804276OtherCOMMUNITY EYE CARE
NCU94142Medicare UPIN
NC804276OtherCOMMUNITY EYE CARE
NC5354440001Medicare NSC