MEDICARE: DR. JUSTIN MAYER OD

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	11307	TX

General Provider Information

NPI Number	:	1619793064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN MAYER OD

Provider Business Mailing Address
First Line	:	1015 NW 38TH AVE
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33993-9316
Country	:	US
Telephone Number	:	210-683-8099
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 W 7TH ST STE 145
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-9301
Country	:	US
Telephone Number	:	210-683-8099
Fax Number	:

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

Provider Enumeration Date	:	12/02/2024
Last Update Date	:	12/06/2024

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Directions to “ DR. JUSTIN MAYER OD” Practice Location

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