Provider Demographics
NPI:1427319508
Name:MYERS, JASON MATTHEW (OD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:MATTHEW
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 1:1604 PROFESSIONAL CIR
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6314
Mailing Address - Country:US
Mailing Address - Phone:405-354-3624
Mailing Address - Fax:405-350-7512
Practice Address - Street 1:1604 PROFESSIONAL CIR
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6314
Practice Address - Country:US
Practice Address - Phone:405-354-3624
Practice Address - Fax:405-350-7512
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2742152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist