Provider Demographics
NPI:1265500730
Name:MEYER, THOMAS JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:MEYER
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 1:3468 SAVANNAH AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110
Mailing Address - Country:US
Mailing Address - Phone:651-777-7120
Mailing Address - Fax:
Practice Address - Street 1:406 ROSEDALE SHOPPING CTR
Practice Address - Street 2:PEARLE VISION
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-3009
Practice Address - Country:US
Practice Address - Phone:651-631-9394
Practice Address - Fax:651-631-9698
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2258152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2201069OtherMEDICA
970481013975OtherPREFERRED ONE
3K202MEOtherBCBS
970481013975OtherPREFERRED ONE