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General NPI Number Information
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NPI Number | 1649063298
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Entity Type | Individual
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Provider Name | RYKER LANE MEYER
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Gender | Male
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Dates
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Enumeration Date | 05/27/2025
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 4013 YELLOWSTONE AVE STE D
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City | POCATELLO
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State | ID
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Zip | 83202-1984
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Country | US
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Telephone | 208-417-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 263 BALLARD RD
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City | POCATELLO
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State | ID
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Zip | 83202-7007
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Country | US
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Telephone | 208-996-9479
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 7171668
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License Number State | ID
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