Provider Demographics
NPI:1144887571
Name:MEYERS, DEREK THOMAS (OD)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:THOMAS
Last Name:MEYERS
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:3445 HENRY ST STE 100
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-4261
Practice Address - Country:US
Practice Address - Phone:231-220-0223
Practice Address - Fax:231-220-0224
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4901005381152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist