MEDICARE: CHRISTOPHER J MEYER

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	4034T171	OH

General Provider Information

NPI Number	:	1235327461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTOPHER J MEYER

Provider Business Mailing Address
First Line	:	PO BOX 520
Second Line	:
City	:	MANTUA
State	:	OH
Zip	:	44255-0520
Country	:	US
Telephone Number	:	330-274-0502
Fax Number	:	330-274-8184

Provider Business Practice Location Address
First Line	:	10730 MAIN ST.,
Second Line	:
City	:	MANTUA
State	:	OH
Zip	:	44255-0520
Country	:	US
Telephone Number	:	330-274-0502
Fax Number	:	330-274-8184

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHRISTOPHER J MEYER
Credential	:	O.D.
Telephone Number	:	330-274-0502

Provider Enumeration Date	:	10/12/2007
Last Update Date	:	12/02/2015

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