MEDICARE: DR. PETRINA L. MEYER 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	1444	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4096228	OTHER	TN	BCBS ADVANTAGE
2	921613	OTHER	TN	BLOCKVISION
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	P00241333	OTHER	TN	PALMETTO GBA
5	TN1444	OTHER	TN	EYEMED VISION
6	4096228	OTHER	TN	TENNCARE SELECT
7	4096228	OTHER	TN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1578564423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETRINA L. MEYER O.D.

Provider Business Mailing Address
First Line	:	1616 W MAIN ST
Second Line	:	SUITE 100
City	:	LEBANON
State	:	TN
Zip	:	37087-3100
Country	:	US
Telephone Number	:	615-453-5155
Fax Number	:	615-444-5915

Provider Business Practice Location Address
First Line	:	1670 W MAIN ST
Second Line	:	SUITE 100
City	:	LEBANON
State	:	TN
Zip	:	37087-1344
Country	:	US
Telephone Number	:	615-453-5155
Fax Number	:	615-444-5915

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. PETRINA L. MEYER O.D.” Practice Location

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