Provider Demographics
NPI:1346258118
Name:MEIER, GARY D (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:D
Last Name:MEIER
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 1:103 DEWEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234
Mailing Address - Country:US
Mailing Address - Phone:618-345-9822
Mailing Address - Fax:
Practice Address - Street 1:415 WEST MAIN STREET
Practice Address - Street 2:STE 7
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-3043
Practice Address - Country:US
Practice Address - Phone:618-345-7887
Practice Address - Fax:618-345-0503
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0466474152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T36018Medicare UPIN
IL286840Medicare ID - Type Unspecified