Provider Demographics
NPI:1346407947
Name:MYERS OPTOMETRY P.S.C.
Entity Type:Organization
Organization Name:MYERS OPTOMETRY P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:606-437-7587
Mailing Address - Street 1:PO BOX 260
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-0260
Mailing Address - Country:US
Mailing Address - Phone:606-437-7587
Mailing Address - Fax:606-437-7035
Practice Address - Street 1:109 CAROLINE AVE
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1101
Practice Address - Country:US
Practice Address - Phone:606-437-7587
Practice Address - Fax:606-437-7035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0966DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY11973OtherCHA
KY77009660Medicaid
KY1388094OtherUNITED MINE WORKERS ASSOCIATION
KY11973OtherCHA
KY0677020001Medicare NSC