Provider Demographics
NPI:1245318260
Name:MYERS, JOSEPH WILLIAM (OD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:WILLIAM
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 1:220 ENTERPRISE DR
Mailing Address - Street 2:INSIDE WAL-MART VISION CENTER
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-2157
Mailing Address - Country:US
Mailing Address - Phone:973-361-6908
Mailing Address - Fax:973-361-6924
Practice Address - Street 1:220 ENTERPRISE DR
Practice Address - Street 2:INSIDE WAL-MART VISION CENTER
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-2157
Practice Address - Country:US
Practice Address - Phone:973-361-6908
Practice Address - Fax:973-361-6924
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00574700152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ27830OtherSPECTERA VISION
NJ926817OtherBLOCK VISION
NJ53046OtherDAVIS VISION
NJ555178OtherNATIONAL VISION ADMIN.
NJ53046OtherDAVIS VISION
NJ068468Medicare ID - Type Unspecified