Provider Demographics
NPI:1619793064
Name:MAYER, JUSTIN (OD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:MAYER
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 1:1015 NW 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33993-9316
Mailing Address - Country:US
Mailing Address - Phone:210-683-8099
Mailing Address - Fax:
Practice Address - Street 1:2600 W 7TH ST STE 145
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-9301
Practice Address - Country:US
Practice Address - Phone:210-683-8099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11307152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist