Provider Demographics
NPI:1578555439
Name:MYERS, RICHARD HARRY (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:HARRY
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 1:8410 W FLAGLER ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2092
Mailing Address - Country:US
Mailing Address - Phone:305-220-7555
Mailing Address - Fax:305-220-6020
Practice Address - Street 1:8410 W FLAGLER ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2092
Practice Address - Country:US
Practice Address - Phone:305-220-7555
Practice Address - Fax:305-220-6020
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2017-07-26
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
FLOPC1240152WC0802X, 152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078391900Medicaid
FL078391900Medicaid
FL19693Medicare ID - Type Unspecified