Provider Demographics
NPI:1124031273
Name:MEYER, ROBIN LESLIE (O D,)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:LESLIE
Last Name:MEYER
Suffix:
Gender:F
Credentials:O D,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 YAQUI DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-7344
Mailing Address - Country:US
Mailing Address - Phone:314-837-6098
Mailing Address - Fax:
Practice Address - Street 1:13901 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-4505
Practice Address - Country:US
Practice Address - Phone:636-256-3285
Practice Address - Fax:636-527-3038
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03189152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO56980Medicare UPIN