Provider Demographics
NPI:1174705198
Name:THOMAS D MYERS MD PC
Entity type:Organization
Organization Name:THOMAS D MYERS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:DYRENG
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-224-3565
Mailing Address - Street 1:280 RIVER PARK DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-5764
Mailing Address - Country:US
Mailing Address - Phone:801-224-3565
Mailing Address - Fax:801-224-3567
Practice Address - Street 1:280 RIVER PARK DR
Practice Address - Street 2:SUITE 220
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-5764
Practice Address - Country:US
Practice Address - Phone:801-224-3565
Practice Address - Fax:801-224-3567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT52144401205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000012679Medicare PIN