MEDICARE: DR. RAYMOND I MYERS O.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	152W00000X	Optometrist	T02173	MO

General Provider Information

NPI Number	:	1356344840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAYMOND I MYERS O.D.

Provider Business Mailing Address
First Line	:	208 BEVERLY LN
Second Line	:
City	:	COLLINSVILLE
State	:	IL
Zip	:	62234-3746
Country	:	US
Telephone Number	:	314-503-3334
Fax Number	:	866-286-2080

Provider Business Practice Location Address
First Line	:	1 UNIVERSITY BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63121-4400
Country	:	US
Telephone Number	:	314-503-3334
Fax Number	:

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	07/08/2007

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