Provider Demographics
NPI:1134318470
Name:JILL K MEYER, O.D., P.C.
Entity Type:Organization
Organization Name:JILL K MEYER, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:K
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:256-737-9109
Mailing Address - Street 1:1400 WALL ST
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-6011
Mailing Address - Country:US
Mailing Address - Phone:256-737-9109
Mailing Address - Fax:256-737-9110
Practice Address - Street 1:1400 WALL ST
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-6011
Practice Address - Country:US
Practice Address - Phone:256-737-9109
Practice Address - Fax:256-737-9110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS576TA128152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALT68995Medicare UPIN
AL0513690002Medicare NSC