Provider Demographics
NPI:1447457270
Name:MYEYEDR OPTOMETRY OF NORTH CAROLINA, PLLC
Entity type:Organization
Organization Name:MYEYEDR OPTOMETRY OF NORTH CAROLINA, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWNES
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 1:313 WB MCLEAN DR
Practice Address - Street 2:
Practice Address - City:CAPE CARTERET
Practice Address - State:NC
Practice Address - Zip Code:28584-8516
Practice Address - Country:US
Practice Address - Phone:252-393-3010
Practice Address - Fax:252-393-3459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2022-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1361152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC699Medicare PIN
NC232116Medicare PIN
NC019JTOtherBCBS
208811294OtherVSP
208811294OtherSUPERIOR VISION SERVICE
208811294OtherTRICARE
NC5906870Medicaid
=========OtherSUPERIOR VISION SERVICE
=========OtherVSP