Provider Demographics
NPI:1083793103
Name:MEYER, RYAN MATTHEW (OD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:MATTHEW
Last Name:MEYER
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 1:1366 US HIGHWAY 41 W
Mailing Address - Street 2:
Mailing Address - City:ISHPEMING
Mailing Address - State:MI
Mailing Address - Zip Code:49849-3152
Mailing Address - Country:US
Mailing Address - Phone:906-485-1300
Mailing Address - Fax:
Practice Address - Street 1:1366 US HIGHWAY 41 W
Practice Address - Street 2:
Practice Address - City:ISHPEMING
Practice Address - State:MI
Practice Address - Zip Code:49849-3152
Practice Address - Country:US
Practice Address - Phone:906-485-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004069152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4271315Medicaid
MIE26345003Medicare ID - Type Unspecified
MI4271315Medicaid
MI0747160001Medicare NSC