Provider Demographics
NPI:1760761779
Name:MEYER, MICHAEL (OD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
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 1:540 MORNING SUN DR
Mailing Address - Street 2:APT 915
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-0656
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3241 S MICHIGAN AVE # 386
Practice Address - Street 2:ILLINOIS COLLEGE OF OPTOMETRY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-4201
Practice Address - Country:US
Practice Address - Phone:949-312-7220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4838152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist