Provider Demographics
NPI:1306915186
Name:MYERS, MATTHEW R (OD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:R
Last Name:MYERS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6484 KEVIN CT
Mailing Address - Street 2:
Mailing Address - City:CLARENCE CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:14032-9163
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4243 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7205
Practice Address - Country:US
Practice Address - Phone:716-633-2440
Practice Address - Fax:716-633-6109
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY6604152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00026988201OtherUNIVERA
NY19920OtherNVA
NY390215004OtherBLUE CROSS BLUE SHIELD
NY735224OtherINDEPENDENT HEALTH
NYNY6604OtherEYEMED
NY735224OtherINDEPENDENT HEALTH
NY19920OtherNVA
NYNY6604OtherEYEMED