Provider Demographics
NPI:1578509873
Name:MYERS, CRESTON MARSHALL (OD)
Entity Type:Individual
Prefix:DR
First Name:CRESTON
Middle Name:MARSHALL
Last Name:MYERS
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:PO BOX 830
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-0830
Mailing Address - Country:US
Mailing Address - Phone:308-762-4056
Mailing Address - Fax:308-762-4063
Practice Address - Street 1:1317 W 3RD ST
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-3125
Practice Address - Country:US
Practice Address - Phone:308-762-4056
Practice Address - Fax:308-762-4063
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2012-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1202152W00000X, 152WC0802X
IA02257152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE37069OtherBCBS OF NEBRASKA
IA35599OtherWELLMARK BCBS
NE37059OtherBCBS
IA35599OtherWELLMARK BCBS
NE37069OtherBCBS OF NEBRASKA
U97270Medicare UPIN
NE279155Medicare PIN