Provider Demographics
NPI:1457355422
Name:MYERS, JEFFREY A (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
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 1:6472 WINCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-2004
Mailing Address - Country:US
Mailing Address - Phone:614-837-9595
Mailing Address - Fax:614-837-8205
Practice Address - Street 1:6472 WINCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-2004
Practice Address - Country:US
Practice Address - Phone:614-837-9595
Practice Address - Fax:614-837-8205
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3765 T6152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0580929Medicaid
OHT48201Medicare UPIN
OHMY0566441Medicare ID - Type Unspecified