Provider Demographics
NPI:1164506333
Name:MYERS, JAMES G (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:G
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 1:10901 WINDHAVEN CT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:OH
Mailing Address - Zip Code:45242-3113
Mailing Address - Country:US
Mailing Address - Phone:513-252-4838
Mailing Address - Fax:513-752-0741
Practice Address - Street 1:3000 FLORENCE MALL
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1431
Practice Address - Country:US
Practice Address - Phone:859-525-4482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3559-T573152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT97123Medicare UPIN
MY0595771Medicare ID - Type Unspecified