Provider Demographics
NPI:1407384134
Name:METZ, DEREK LAWRENCE (OD)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:LAWRENCE
Last Name:METZ
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 1:400 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-2318
Mailing Address - Country:US
Mailing Address - Phone:937-773-8023
Mailing Address - Fax:937-773-8762
Practice Address - Street 1:400 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-2318
Practice Address - Country:US
Practice Address - Phone:937-773-8023
Practice Address - Fax:937-773-8762
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-25
Last Update Date:2017-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6564152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist