Provider Demographics
NPI:1982757720
Name:JOSEPH W MYERS OD INC
Entity type:Organization
Organization Name:JOSEPH W MYERS OD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:WINFRED
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-845-1560
Mailing Address - Street 1:PO BOX 708
Mailing Address - Street 2:
Mailing Address - City:MOUNDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26041-0708
Mailing Address - Country:US
Mailing Address - Phone:304-845-1560
Mailing Address - Fax:304-845-6381
Practice Address - Street 1:511 5TH ST
Practice Address - Street 2:
Practice Address - City:MOUNDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26041-1901
Practice Address - Country:US
Practice Address - Phone:304-845-1560
Practice Address - Fax:304-845-6381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV567-D152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1982757720OtherCORPORATION NPI NUMBER
WV001720036OtherBLUECROSS PAY TO NUMBER
WV3810011960OtherMEDICAID GROUP NUMBER
WV567OtherHEALTHPLAN UPPER OHIO VAL
1063491082OtherINDIVIDUAL NPI NUMBER
DD7795OtherRAILROAD MEDICARE GROUP N
WA000067780OtherBLUE CROSS PROVIDER NUMBE
P00250559OtherRAILROAD MEDICARE PIN
WV0150358000Medicaid
WV001720036OtherBLUECROSS PAY TO NUMBER
P00250559OtherRAILROAD MEDICARE PIN
WV3810011960OtherMEDICAID GROUP NUMBER