Provider Demographics
NPI:1235341058
Name:MYERS, CARL O (OD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:O
Last Name:MYERS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10343 DAWSONS CREEK BLVD
Mailing Address - Street 2:STE B, BLDG 6
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1906
Mailing Address - Country:US
Mailing Address - Phone:260-497-7973
Mailing Address - Fax:260-497-7986
Practice Address - Street 1:10343 DAWSONS CREEK BLVD
Practice Address - Street 2:STE B, BLDG 6
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1906
Practice Address - Country:US
Practice Address - Phone:260-497-7973
Practice Address - Fax:260-497-7986
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002177A152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200427750AMedicaid
IN1821059320OtherCORPORATION NPI
INT69280Medicare UPIN