Provider Demographics
NPI:1467410225
Name:MEYERS, STEVEN MARK (OD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:MARK
Last Name:MEYERS
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 1:1022 WILLOW CREEK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1607
Mailing Address - Country:US
Mailing Address - Phone:928-445-1341
Mailing Address - Fax:
Practice Address - Street 1:1022 WILLOW CREEK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1607
Practice Address - Country:US
Practice Address - Phone:928-445-1341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ530152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ037102Medicaid
T76869Medicare UPIN
AZ037102Medicaid