Provider Demographics
NPI:1265463483
Name:MYERS, MARTHA ELLEN (OD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:ELLEN
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 1:1521 ASBURY LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-6212
Mailing Address - Country:US
Mailing Address - Phone:479-527-9790
Mailing Address - Fax:479-527-9792
Practice Address - Street 1:2875 W MLK BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-7625
Practice Address - Country:US
Practice Address - Phone:479-527-9790
Practice Address - Fax:479-527-9792
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2490152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR137088722Medicaid
ARU75575Medicare UPIN
AR49575Medicare ID - Type Unspecified