DR. JACQUELYN TYRA OD
NPI 1154896363
Optometrist in Ashburn, VA

Active since October 04, 2018PECOS EnrolledAccepts Medicare Assignment
43490 YUKON DR STE 200, ASHBURN, VA 20147(703) 724-0330 Get Directions Write a Review

NPPES record last updated: May 23, 2023. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: May 23, 2023, Nov 21, 2022, Sep 8, 2019 and 1 more (4 updates tracked since 2018).

About Dr. Jacquelyn Tyra Od NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JACQUELYN TYRA OD (NPI 1154896363) is an individual optometrist in Ashburn, Virginia, licensed in Virginia (0618002779) and active in the NPI registry since October 2018. She is enrolled in Medicare PECOS and is a graduate of University Of Missouri St Louis - School Of Optometry (2019).

NPPES Registry Identity

NPI1154896363
Entity TypeIndividualFemale
Primary Taxonomy152W00000X
Provider Legal NameDR. JACQUELYN TYRACredential: OD
Location Address43490 YUKON DR STE 200Ashburn, VA 20147-7315
Mailing Address21735 Pinewood CtSterling, VA 20164-2300 · (703) 304-2459
Sole ProprietorYes
Medical School CMSUniversity Of Missouri St Louis - School Of OptometryGraduated 2019
Enumeration DateOctober 4, 2018
Last NPPES UpdateMay 23, 20234 updates tracked since enumeration
NPPES CertifiedMay 23, 2023
NPI 1154896363 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyOptometristEye and Vision Services Providers
Taxonomy Code152W00000X
License Licensed in VA · 0618002779
Definition

Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.

43490 YUKON DR STE 200, Ashburn, VA 20147

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Dr. Jacquelyn Tyra Od is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID648646869
PECOS Enrollment IDI20221013000229
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203
This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.
14 services14 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 20147 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$129.04 typical visit price
range $56.19 – $170.30
Typical copayment $32.26 (range $14.04 – $42.57)
Most-billed visit code 99204
Established Patient
$70.08 typical visit price
range $18.07 – $138.91
Typical copayment $17.52 (range $4.51 – $34.72)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jacquelyn Tyra's NPI number?

The NPI number for Jacquelyn Tyra is 1154896363. It was assigned to this individual provider in the NPPES registry on October 4, 2018.

Where is Jacquelyn Tyra located?

Jacquelyn Tyra practices at 43490 Yukon Dr Ste 200, Ashburn, VA 20147. The listed phone number is (703) 724-0330.

What is Jacquelyn Tyra's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Is Jacquelyn Tyra enrolled in Medicare?

Yes. Jacquelyn Tyra is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Jacquelyn Tyra accept?

Health plans from Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and Providence Health Plan list Jacquelyn Tyra as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Jacquelyn Tyra was last updated on May 23, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.