Provider Demographics
NPI:1538381587
Name:MEYERS, JON KENNETH (DO)
Entity type:Individual
Prefix:MR
First Name:JON
Middle Name:KENNETH
Last Name:MEYERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:858 W BENJAMIN HOLT DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-3652
Mailing Address - Country:US
Mailing Address - Phone:209-476-0913
Mailing Address - Fax:209-476-9792
Practice Address - Street 1:858 W BENJAMIN HOLT DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-3652
Practice Address - Country:US
Practice Address - Phone:209-476-0913
Practice Address - Fax:209-476-9792
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD 3783156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician