Provider Demographics
NPI:1871647917
Name:MYERS, JAMES LYNN II (OD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LYNN
Last Name:MYERS
Suffix:II
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1789 E BRISTOL ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-6607
Mailing Address - Country:US
Mailing Address - Phone:574-262-3631
Mailing Address - Fax:574-266-9186
Practice Address - Street 1:1789 E BRISTOL ST
Practice Address - Street 2:SUITE C
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-6607
Practice Address - Country:US
Practice Address - Phone:574-262-3631
Practice Address - Fax:574-266-9186
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ18001630B152W00000X
IN180012689B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ININ1630OtherEYEMED VISION CARE
IN100325330Medicaid
ININ2496001Medicare PIN
IN0482840001Medicare NSC
ININ1630OtherEYEMED VISION CARE