Provider Demographics
NPI:1356320253
Name:MYERS, CLIFFORD EARL (MD)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:EARL
Last Name:MYERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8921 N WOOD SAGE RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-7822
Mailing Address - Country:US
Mailing Address - Phone:309-243-2400
Mailing Address - Fax:309-243-7918
Practice Address - Street 1:5401 N KNOXVILLE AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-5098
Practice Address - Country:US
Practice Address - Phone:309-693-2710
Practice Address - Fax:309-693-9460
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-060306207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1356320253Medicaid
IL1376711283Medicare PIN
ILD14808Medicare UPIN
IL1356320253Medicaid