DR. JACQUELYN TYRA (OD) – Optometrist, NPI 1154896363
Optometrist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
959 OPTOMETRY in GA
Provider Addresses for DR. JACQUELYN TYRA (OD)
6311, Wilmington Drive, Meadow Pond, Burke Centre, Burke, Fairfax County, Virginia, 22015, United States
BURKE, VA 220154042
Phone: (703) 304-2459
Type: Mailing
9220 MARNE RD
FORT BENNING, GA 31905
Phone: (706) 682-3938
Type: Location
8500 FRANCISCAN WOODS DR APT 808
COLUMBUS, GA 319095674
Phone: (703) 304-2459
Type: Mailing
21735 PINEWOOD CT
STERLING, VA 201642300
Phone: (703) 304-2459
Type: Mailing
43490 YUKON DR STE 200
ASHBURN, VA 201477315
Phone: (703) 724-0330
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 11 Open Payments records for all available years, with a total value of $338.
Total Amount is formed as General ($338) + Research ($0) + Ownership ($0) = $338.
Last reported payment date: 2024-10-30 • Largest payer in this snapshot: Bausch & Lomb Americas Inc. ($162).
Total Amount
$338
General + Research + Ownership
Payments
11
Total payment records
General Amount
$338
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-10-30
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Bausch & Lomb Americas Inc. | $162 |
| Alcon Vision LLC | $77 |
| Oyster Point Pharma, Inc. | $71 |
| CooperVision Inc. | $28 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2022-10-13
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20221013000229 | I | Optometry | VA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 22015)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| O P T O M E T R Y | VA | |
| O P T O M E T R Y | VA |
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