Healthcare Provider Details

I. General information

NPI: 1346986205
Provider Name (Legal Business Name): MYERS OPTOMETRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2022
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 GREEN BAY RD
WINNETKA IL
60093-1719
US

IV. Provider business mailing address

910 GREEN BAY RD
WINNETKA IL
60093-1719
US

V. Phone/Fax

Practice location:
  • Phone: 636-399-5826
  • Fax:
Mailing address:
  • Phone: 636-399-5826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DANIEL MYERS
Title or Position: OPTOMETRIST
Credential: OD
Phone: 636-399-5826