Provider Demographics
NPI:1063491082
Name:MYERS, JOSEPH WINFRED (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:WINFRED
Last Name:MYERS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 5TH ST
Mailing Address - Street 2:MYERS EYE CLINIC
Mailing Address - City:MOUNDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26041
Mailing Address - Country:US
Mailing Address - Phone:304-845-1560
Mailing Address - Fax:304-845-6381
Practice Address - Street 1:511 5TH ST
Practice Address - Street 2:MYERS EYE CLINIC
Practice Address - City:MOUNDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26041
Practice Address - Country:US
Practice Address - Phone:304-845-1560
Practice Address - Fax:304-845-6381
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV567D152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV567OtherHMO
WV0150358000Medicaid
WV9279751Medicare ID - Type Unspecified
T32237Medicare UPIN