Provider Demographics
NPI:1093982720
Name:MYER, DAN L (FCLSA, LDO)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:L
Last Name:MYER
Suffix:
Gender:M
Credentials:FCLSA, LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 EQUESTRIAN WAY NE
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30121-8032
Mailing Address - Country:US
Mailing Address - Phone:404-323-2020
Mailing Address - Fax:404-412-2020
Practice Address - Street 1:1995 N PARK PL SE
Practice Address - Street 2:SUITE 310P
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-7801
Practice Address - Country:US
Practice Address - Phone:404-323-2020
Practice Address - Fax:404-412-2020
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO1683156FC0800X
GAGA1683156FX1800X, 156FC0801X, 246ZB0301X, 156FC0800X, 335E00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact LensGroup - Single Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
No246ZB0301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherBiomedical EngineeringGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic Supplier
No332H00000XSuppliersEyewear Supplier