Provider Demographics
NPI:1568918225
Name:MYERS, ISABELLA SAMANTHA (OD)
Entity Type:Individual
Prefix:MRS
First Name:ISABELLA
Middle Name:SAMANTHA
Last Name:MYERS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MISS
Other - First Name:ISABELLA
Other - Middle Name:SAMANTHA
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:30 DOTS CIRCLE
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-6313
Mailing Address - Country:US
Mailing Address - Phone:408-607-3990
Mailing Address - Fax:
Practice Address - Street 1:8050 SANTA TERESA BLVD
Practice Address - Street 2:#110
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-3862
Practice Address - Country:US
Practice Address - Phone:408-842-2020
Practice Address - Fax:408-842-0312
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33538152W00000X
CA33538TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist