Provider Demographics
NPI:1235327461
Name:CHRISTOPHER J MEYER
Entity Type:Organization
Organization Name:CHRISTOPHER J MEYER
Other - Org Name:THE MANTUA EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-274-0502
Mailing Address - Street 1:PO BOX 520
Mailing Address - Street 2:
Mailing Address - City:MANTUA
Mailing Address - State:OH
Mailing Address - Zip Code:44255-0520
Mailing Address - Country:US
Mailing Address - Phone:330-274-0502
Mailing Address - Fax:330-274-8184
Practice Address - Street 1:10730 MAIN ST.,
Practice Address - Street 2:
Practice Address - City:MANTUA
Practice Address - State:OH
Practice Address - Zip Code:44255-0520
Practice Address - Country:US
Practice Address - Phone:330-274-0502
Practice Address - Fax:330-274-8184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4034T171152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU27108Medicare UPIN
OH0808340001Medicare NSC
OH9269621Medicare PIN