Provider Demographics
NPI:1902054380
Name:MEYLIKER, GREGORY (OPTICIAN)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:MEYLIKER
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 LEMOINE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6041
Mailing Address - Country:US
Mailing Address - Phone:201-242-0300
Mailing Address - Fax:
Practice Address - Street 1:2151 LEMOINE AVE
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6041
Practice Address - Country:US
Practice Address - Phone:201-242-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00343500156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ31TD00343500OtherOPTICIAN LICIENSE