Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0800X | Contact Lens | GA1683 | GA |
N | 156FC0800X | Contact Lens | LDO1683 | GA |
Y | 156FC0801X | Contact Lens Fitter | GA1683 | GA |
N | 156FX1800X | Optician | GA1683 | GA |
NPI | 1093982720 |
---|---|
Provider Name | Dan L Myer |
First Address | Cartersville, GA 30121-8032 |
Second Address | Atlanta, GA 30339-7801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2008 |
Last Update Date | 08/02/2017 |