Provider Demographics
NPI:1750320800
Name:MYERS, DOUGLAS RICHARD (OD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:RICHARD
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 1:119 YELLOWSTONE DR
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-5811
Mailing Address - Country:US
Mailing Address - Phone:530-891-1146
Mailing Address - Fax:530-891-0123
Practice Address - Street 1:119 YELLOWSTONE DR
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-5811
Practice Address - Country:US
Practice Address - Phone:530-891-1146
Practice Address - Fax:530-891-0123
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5438 T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD000690Medicaid
CASD0054380Medicare ID - Type Unspecified
CAGSD000690Medicaid
CAZZZ39453ZMedicare ID - Type UnspecifiedMEDICARE GROUP ID NUMBER