Provider Demographics
NPI:1598764151
Name:MEYER, NORMAN ISAAC (MD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:ISAAC
Last Name:MEYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 WOODSTORK WAY
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-5237
Mailing Address - Country:US
Mailing Address - Phone:772-581-0526
Mailing Address - Fax:772-571-6084
Practice Address - Street 1:107 WOODSTORK WAY
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-5237
Practice Address - Country:US
Practice Address - Phone:772-581-0526
Practice Address - Fax:772-571-6084
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-17
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME29272207W00000X
FLME029272208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDD0933OtherRRB PTAN
FL059021500Medicaid
FL03348BMedicare PIN
FL059021500Medicaid