MEDICARE: KENNETH MEYER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	G39669	CA

General Provider Information

NPI Number	:	1003185836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH MEYER M.D.

Provider Business Mailing Address
First Line	:	125 GOOSE BAY VIEW TRL
Second Line	:
City	:	CHESTER
State	:	CA
Zip	:	96020-9737
Country	:	US
Telephone Number	:	530-419-5030
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 GOOSE BAY VIEW TRL
Second Line	:
City	:	CHESTER
State	:	CA
Zip	:	96020-9737
Country	:	US
Telephone Number	:	530-419-5030
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2011
Last Update Date	:	12/23/2011

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