MEDICARE: DR. LUCIAS DANIEL MEYER 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	2005021612	MO

General Provider Information

NPI Number	:	1720032600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUCIAS DANIEL MEYER O.D.

Provider Business Mailing Address
First Line	:	PO BOX 207158
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75320-7158
Country	:	US
Telephone Number	:	636-200-4393
Fax Number	:	636-527-0766

Provider Business Practice Location Address
First Line	:	230 N LINDBERGH BLVD
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-5904
Country	:	US
Telephone Number	:	314-921-9377
Fax Number	:	314-830-2940

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

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	05/28/2021

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