Poolesville Vision Service is a medicare enrolled "Optometrist" provider in Poolesville, Maryland. Their current practice location is
20005 B Fisher Ave, Poolesville, Maryland. You can reach out to their office (for appointments etc.) via phone at
(301) 916-3214.
Poolesville Vision Service is licensed to practice in Maryland (license number TA1222) and it also participates in the medicare program. Poolesville Vision Service
is enrolled with medicare and should accept medicare assignments and since they are enrolled in medicare, they may order Medicare Part D Prescription drugs, if eligible. The facility's NPI Number is 1114206943.
Healthcare Provider's Profile
Full Name | Poolesville Vision Service |
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Type | Facility |
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Speciality | Optometrist |
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Location | 20005 B Fisher Ave, Poolesville, Maryland |
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Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1114206943
- Provider Enumeration Date: 08/10/2011
- Last Update Date: 08/09/2018
Medicare PECOS Information:
- PECOS PAC ID: 3678826179
- Enrollment ID: O20181031000700
Medical Identifiers
Medical identifiers for Poolesville Vision Service such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1114206943 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
152W00000X | Optometrist | TA1222 (Maryland) | Primary |
152WC0802X | Optometrist - Corneal And Contact Management | TA1222 (Maryland) | Secondary |
152WL0500X | Optometrist - Low Vision Rehabilitation | TA1222 (Maryland) | Secondary |
152WP0200X | Optometrist - Pediatrics | TA1222 (Maryland) | Secondary |
152WS0006X | Optometrist - Sports Vision | TA1222 (Maryland) | Secondary |
152WV0400X | Optometrist - Vision Therapy | TA1222 (Maryland) | Secondary |
152WX0102X | Optometrist - Occupational Vision | TA1222 (Maryland) | Secondary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works.
Poolesville Vision Service acts as a billing entity for following providers:
Provider Name | Robin Mevissen |
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Provider Type | Practitioner - Optometry |
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Provider Identifiers | NPI Number: 1164500864 PECOS PAC ID: 5092819045 Enrollment ID: I20110421000439 |
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Provider Name | Thomas K Mcinnes |
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Provider Type | Practitioner - Optometry |
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Provider Identifiers | NPI Number: 1447312061 PECOS PAC ID: 3678756020 Enrollment ID: I20120222000768 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Poolesville Vision Service is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Poolesville Vision Service 20005 B Fisher Ave, Poolesville, MD 20837-2408 Ph: (301) 916-3214 | Poolesville Vision Service 20005 B Fisher Ave, Poolesville, MD 20837-2408 Ph: (301) 916-3214 |
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