Provider Demographics
NPI:1134262637
Name:MYERS, ROCHELLE ANN (OD)
Entity type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:ANN
Last Name:MYERS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 E UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-8436
Mailing Address - Country:US
Mailing Address - Phone:480-892-8400
Mailing Address - Fax:480-892-9533
Practice Address - Street 1:3321 E BELL RD
Practice Address - Street 2:STE. B12
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2755
Practice Address - Country:US
Practice Address - Phone:602-787-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1560152W00000X
UT2692759934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1560OtherAZ STATE BOARD OF OPTOMETRY
AZ222491Medicaid