Provider Demographics
NPI:1922107465
Name:JAMES L MYERS II O.D. P.C.
Entity Type:Organization
Organization Name:JAMES L MYERS II O.D. P.C.
Other - Org Name:SCOTT OPTICAL/ EYE CARE ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:II
Authorized Official - Credentials:OD
Authorized Official - Phone:574-262-3631
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ18001630B152W00000X
IN180012689B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN2623631OtherVSP
INE7JT0000OtherMEDICARE GROUP
IN100232810Medicaid
IN2623631OtherVSP
IN100232810Medicaid
IN100232810Medicaid
IN100232810Medicaid