Provider Demographics
NPI:1538117031
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 1:714 N HIGHWAY ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NC
Practice Address - Zip Code:27025-1508
Practice Address - Country:US
Practice Address - Phone:336-427-2020
Practice Address - Fax:336-427-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
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
NCP00094877OtherRRMCR INDIVIDUAL
NC09406OtherBCBS GRP #
NC8909406Medicaid
NCDB2486OtherRAILROAD MEDICARE GROUP #
NCP00094877OtherRRMCR INDIVIDUAL
NC0139010010Medicare NSC