Healthcare Provider Details

I. General information

NPI: 1366427239
Provider Name (Legal Business Name): FREDERICK MICHAEL MEYER O.D. (OPTOMETRIST)
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5342 DUDLEY BLVD
MCCLELLAN CA
95652-1012
US

IV. Provider business mailing address

1005 CROATIA CT
ROSEVILLE CA
95661-6300
US

V. Phone/Fax

Practice location:
  • Phone: 916-561-7533
  • Fax:
Mailing address:
  • Phone: 916-786-3708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2382
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: