Provider Demographics
NPI:1578564423
Name:MEYER, PETRINA L (OD)
Entity Type:Individual
Prefix:DR
First Name:PETRINA
Middle Name:L
Last Name:MEYER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 W MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-3100
Mailing Address - Country:US
Mailing Address - Phone:615-453-5155
Mailing Address - Fax:615-444-5915
Practice Address - Street 1:1670 W MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-1344
Practice Address - Country:US
Practice Address - Phone:615-453-5155
Practice Address - Fax:615-444-5915
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1444152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4096228OtherBCBS ADVANTAGE
TN921613OtherBLOCKVISION
TN3946497Medicaid
TNP00241333OtherPALMETTO GBA
TNTN1444OtherEYEMED VISION
TN4096228OtherTENNCARE SELECT
TN4096228OtherBLUE CROSS BLUE SHIELD
TNTN1444OtherEYEMED VISION
TN3946497Medicaid