Provider Demographics
NPI:1083601280
Name:MYERS, SUE ELLEN (OD)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:ELLEN
Last Name:MYERS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4313 I 49 S SERVICE RD
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-0755
Mailing Address - Country:US
Mailing Address - Phone:337-942-2024
Mailing Address - Fax:337-948-6216
Practice Address - Street 1:4313 I 49 S SERVICE RD
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-0755
Practice Address - Country:US
Practice Address - Phone:337-942-2024
Practice Address - Fax:337-948-6216
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA993-236T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1354945Medicaid
LAT19426Medicare UPIN
LA1354945Medicaid