Organization
MYEYEDR OPTOMETRY OF NORTH CAROLINA PLLC
Active
Other names
MyEyeDr
Organization subpart
No
Provider details
NPI number
Authorized official
SUE HEALEY (SECRETARY)
(703) 847-8899
Entity
Organization
Contact information
Practice address
12205 CAPITAL BLVD, WAKE FOREST, NC 27587-6200
(919) 554-2020
(919) 556-4047
Mailing address
8614 WESTWOOD CENTER DR FL 9, VIENNA, VA 22182-2442
(703) 847-8899
(571) 223-6780
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0111A
BCBS GROUP #
NC
01
—
540004216
RR MEDICARE GROUP #
NC
05
—
5900512
—
NC
Enumeration date
05/02/2006
Last updated
05/29/2022
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