Provider Demographics
NPI:1285751552
Name:MEYER OPTICAL CO. INC.
Entity type:Organization
Organization Name:MEYER OPTICAL CO. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:VIDAS
Authorized Official - Suffix:
Authorized Official - Credentials:0D
Authorized Official - Phone:815-939-2222
Mailing Address - Street 1:135 W RIVER ST
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1964
Mailing Address - Country:US
Mailing Address - Phone:815-939-2222
Mailing Address - Fax:815-939-0970
Practice Address - Street 1:135 W RIVER ST
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1964
Practice Address - Country:US
Practice Address - Phone:815-939-2222
Practice Address - Fax:815-939-0970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0303980001Medicare NSC