Provider Demographics
NPI:1518010495
Name:OPTOMETRIC SERVICES, LLC
Entity Type:Organization
Organization Name:OPTOMETRIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:651-592-8422
Mailing Address - Street 1:3468 SAVANNAH AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-4579
Mailing Address - Country:US
Mailing Address - Phone:651-592-8422
Mailing Address - Fax:
Practice Address - Street 1:406 ROSEDALE CENTER
Practice Address - Street 2:PEARLE VISION EXPRESS
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113
Practice Address - Country:US
Practice Address - Phone:651-631-9394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2258152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty