Provider Demographics
NPI:1265403539
Name:MEYER, CHRISTOPHER J
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:J
Last Name:MEYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10730 MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:MANTUA
Mailing Address - State:OH
Mailing Address - Zip Code:44255-0520
Mailing Address - Country:US
Mailing Address - Phone:330-274-0502
Mailing Address - Fax:330-274-8184
Practice Address - Street 1:10730 MAIN ST.
Practice Address - Street 2:
Practice Address - City:MANTUA
Practice Address - State:OH
Practice Address - Zip Code:44255-0520
Practice Address - Country:US
Practice Address - Phone:330-274-0502
Practice Address - Fax:330-274-8184
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4034 T171152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0653363Medicare PIN
OHU27108Medicare UPIN