Provider Demographics
NPI:1740224898
Name:MYERS, JEFFERY BRAXTON (OD,PA)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:BRAXTON
Last Name:MYERS
Suffix:
Gender:M
Credentials:OD,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 E ROBINSON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-7113
Mailing Address - Country:US
Mailing Address - Phone:479-756-6500
Mailing Address - Fax:479-756-8577
Practice Address - Street 1:830 E ROBINSON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-7113
Practice Address - Country:US
Practice Address - Phone:479-756-6500
Practice Address - Fax:479-756-8577
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR2519152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1740224898OtherNPIN
AR154205722Medicaid
AR154205722Medicaid
AR1740224898OtherNPIN
ARU99628Medicare UPIN