Provider Demographics
NPI:1538185319
Name:MEYER, VICTOR M (OD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:M
Last Name:MEYER
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 1:101 DEER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172-9778
Mailing Address - Country:US
Mailing Address - Phone:812-246-2943
Mailing Address - Fax:
Practice Address - Street 1:101 DEER CREEK DR
Practice Address - Street 2:
Practice Address - City:SELLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47172-9778
Practice Address - Country:US
Practice Address - Phone:812-246-2943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003261A152W00000X
KY1604DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU97542Medicare UPIN