Provider Demographics
NPI:1093824799
Name:MYERS, JOSEPH (OD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
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 1:207 FLETCHER
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-1050
Mailing Address - Country:US
Mailing Address - Phone:734-763-0291
Mailing Address - Fax:734-647-8828
Practice Address - Street 1:207 FLETCHER
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-1050
Practice Address - Country:US
Practice Address - Phone:734-763-0291
Practice Address - Fax:734-647-8828
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003202152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIUH810009OtherMCARE
U35114Medicare UPIN
MION10080002Medicare ID - Type Unspecified