Provider Demographics
NPI:1255402715
Name:MYERS, THOMAS ARTHUR (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ARTHUR
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 1:5011 W LOWELL AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-8587
Mailing Address - Country:US
Mailing Address - Phone:509-868-0215
Mailing Address - Fax:509-868-0245
Practice Address - Street 1:5011 W LOWELL AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-8587
Practice Address - Country:US
Practice Address - Phone:509-868-0215
Practice Address - Fax:509-868-0245
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD3853152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2005120OtherORGANIZATION MEDICAID # X PACIFIC EYECARE
WA0256880OtherLABOR & INDUSTRIES
WA2031060Medicaid
WAG8889734OtherMEDICARE PTAN
WA2031060Medicaid
WAU99096Medicare UPIN