Provider Demographics
NPI:1053484634
Name:MEYERS, JOHN L
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:MEYERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9409 US HIGHWAY 19
Mailing Address - Street 2:SUITE #504
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-4625
Mailing Address - Country:US
Mailing Address - Phone:727-845-5506
Mailing Address - Fax:
Practice Address - Street 1:9409 US HIGHWAY 19
Practice Address - Street 2:SUITE #504
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-4625
Practice Address - Country:US
Practice Address - Phone:727-845-5506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL3195152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620901700Medicaid
FLK9223Medicare ID - Type Unspecified
FLU66493Medicare UPIN