Provider Demographics
NPI:1023074093
Name:MYERS, THOMAS DYRENG (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:DYRENG
Last Name:MYERS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:280 RIVER PARK DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-5764
Mailing Address - Country:US
Mailing Address - Phone:801-224-3565
Mailing Address - Fax:801-224-3567
Practice Address - Street 1:280 RIVER PARK DR
Practice Address - Street 2:SUITE 220
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-5764
Practice Address - Country:US
Practice Address - Phone:801-224-3565
Practice Address - Fax:801-224-3567
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT5214440-1205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTH87103Medicare UPIN