Provider Demographics
NPI:1356309116
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:
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 1:12205 CAPITAL BLVD
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6200
Practice Address - Country:US
Practice Address - Phone:919-554-2020
Practice Address - Fax:919-556-4047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2022-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0111AOtherBCBS GROUP #
NC540004216OtherRR MEDICARE GROUP #
NC5900512Medicaid
NC0111AOtherBCBS GROUP #
NC540004216OtherRR MEDICARE GROUP #