Provider Demographics
NPI:1821099367
Name:MEYER, DARREN LEE (OD)
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:LEE
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 1:26289 W CHICAGO RD
Mailing Address - Street 2:PO BOX 128
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091-8706
Mailing Address - Country:US
Mailing Address - Phone:269-651-7874
Mailing Address - Fax:269-651-4154
Practice Address - Street 1:26289 W CHICAGO RD
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091-8706
Practice Address - Country:US
Practice Address - Phone:269-651-7874
Practice Address - Fax:269-651-4154
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004365152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4863666Medicaid
U76589Medicare UPIN
N86090003Medicare PIN