MEDICARE: DR. CONSTANCE RUTH MYERS O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPC1972	FL
2	152WC0802X	Corneal and Contact Management Optometrist	OPC1972	FL

General Provider Information

NPI Number	:	1144624818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CONSTANCE RUTH MYERS O.D.

Provider Business Mailing Address
First Line	:	7303 SW 88TH ST
Second Line	:	3RD FLOOR ( LENSCRAFTERS OPTIQUE AT MACY S)
City	:	MIAMI
State	:	FL
Zip	:	33156-7801
Country	:	US
Telephone Number	:	305-662-3003
Fax Number	:	305-662-3005

Provider Business Practice Location Address
First Line	:	7303 SW 88TH ST
Second Line	:	3RD FLOOR ( LENSCRAFTERS OPTIQUE AT MACY S)
City	:	MIAMI
State	:	FL
Zip	:	33156-7801
Country	:	US
Telephone Number	:	305-662-3003
Fax Number	:	305-662-3005

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2014
Last Update Date	:	10/09/2014

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