Healthcare Provider Details

I. General information

NPI: 1164151569
Provider Name (Legal Business Name): PEYTON LEE MYERS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 06/09/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 ROBINS SQUARE DR
ROBINS IA
52328-9649
US

IV. Provider business mailing address

725 CIMMARON DR
NEVADA IA
50201-2285
US

V. Phone/Fax

Practice location:
  • Phone: 319-294-8888
  • Fax: 319-294-4299
Mailing address:
  • Phone: 515-509-6319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number114562
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: