Provider Demographics
NPI:1184781841
Name:MYERS, JOSEPH (OD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:MYERS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12361 W BOLA DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85378-9021
Mailing Address - Country:US
Mailing Address - Phone:602-767-4124
Mailing Address - Fax:602-767-4125
Practice Address - Street 1:12361 W BOLA DR STE 100
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85378-9021
Practice Address - Country:US
Practice Address - Phone:602-767-4124
Practice Address - Fax:602-767-4125
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1558152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ113194Medicare PIN
AZZ162074Medicare PIN
AZZ162075Medicare PIN
AZZ162077Medicare PIN
AZZ163933Medicare PIN
AZZ163929Medicare PIN
AZZ163928Medicare PIN
AZZ163930Medicare PIN
AZZ162079Medicare PIN
AZZ162078Medicare PIN
AZZ163931Medicare PIN
AZZ162076Medicare PIN
AZZ163932Medicare PIN