Healthcare Provider Details

I. General information

NPI: 1598764151
Provider Name (Legal Business Name): NORMAN ISAAC MEYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2005
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 WOODSTORK WAY
SEBASTIAN FL
32958-5237
US

IV. Provider business mailing address

107 WOODSTORK WAY
SEBASTIAN FL
32958-5237
US

V. Phone/Fax

Practice location:
  • Phone: 772-581-0526
  • Fax: 772-571-6084
Mailing address:
  • Phone: 772-581-0526
  • Fax: 772-571-6084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME29272
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME029272
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: