Provider Demographics
NPI:1942489620
Name:DANIEL J. MAYER, M.D. INC
Entity Type:Organization
Organization Name:DANIEL J. MAYER, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-725-4174
Mailing Address - Street 1:4067 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-5622
Mailing Address - Country:US
Mailing Address - Phone:330-725-4174
Mailing Address - Fax:330-725-4080
Practice Address - Street 1:4067 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-5622
Practice Address - Country:US
Practice Address - Phone:330-725-4174
Practice Address - Fax:330-725-4080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH053557207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0628128Medicaid
OHCN7360OtherRETIRED RAILROAD MEDICARE
OH000000029208OtherBCBS
OH000000029208OtherBCBS
OH9292001Medicare PIN
OH9292002Medicare PIN
OHCN7360OtherRETIRED RAILROAD MEDICARE