1982757720 NPI number — JOSEPH W MYERS OD INC

Table of content: (NPI 1982757720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982757720 NPI number — JOSEPH W MYERS OD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSEPH W MYERS OD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MYERS EYE CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982757720
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 708
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNDSVILLE
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26041-0708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-845-1560
Provider Business Mailing Address Fax Number:
304-845-6381

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
511 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNDSVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26041-1901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-845-1560
Provider Business Practice Location Address Fax Number:
304-845-6381
Provider Enumeration Date:
01/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MYERS
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
WINFRED
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
304-845-1560

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  567-D , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1982757720 . This is a "CORPORATION NPI NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001720036 . This is a "BLUECROSS PAY TO NUMBER" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 3810011960 . This is a "MEDICAID GROUP NUMBER" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 567 . This is a "HEALTHPLAN UPPER OHIO VAL" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 1063491082 . This is a "INDIVIDUAL NPI NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: DD7795 . This is a "RAILROAD MEDICARE GROUP N" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000067780 . This is a "BLUE CROSS PROVIDER NUMBE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: P00250559 . This is a "RAILROAD MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0150358000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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