Provider Demographics
NPI:1720032600
Name:MEYER, LUCIAS DANIEL (OD)
Entity Type:Individual
Prefix:DR
First Name:LUCIAS
Middle Name:DANIEL
Last Name:MEYER
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 207158
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-7158
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-527-0766
Practice Address - Street 1:230 N LINDBERGH BLVD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-5904
Practice Address - Country:US
Practice Address - Phone:314-921-9377
Practice Address - Fax:314-830-2940
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005021612152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO112000030Medicare PIN
MOVO6632Medicare UPIN
MO000014719Medicare ID - Type Unspecified