Provider Demographics
NPI:1316015373
Name:MYERS, JERIMIAH L (OD)
Entity Type:Individual
Prefix:DR
First Name:JERIMIAH
Middle Name:L
Last Name:MYERS
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:PO BOX 1948
Mailing Address - Street 2:214 W REZANOF STE 1
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615
Mailing Address - Country:US
Mailing Address - Phone:907-486-6117
Mailing Address - Fax:907-486-6140
Practice Address - Street 1:214 W REZANOF
Practice Address - Street 2:STE 1
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615
Practice Address - Country:US
Practice Address - Phone:907-486-6117
Practice Address - Fax:907-486-6140
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2008-01-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AKAA0102152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKK152523Medicare UPIN