=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932218120
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEYER FAMILY VISION, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 02/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1366 US HIGHWAY 41 W
-----------------------------------------------------
City | ISHPEMING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49849-3152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-485-1300
-----------------------------------------------------
Fax | 906-485-4040
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1366 US HIGHWAY 41 W
-----------------------------------------------------
City | ISHPEMING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49849-3152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-485-1300
-----------------------------------------------------
Fax | 906-485-4040
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. SARA BETH MEYER
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 906-485-1300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 4901003638
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 4901004069
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 4901003639
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------