Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 29367 | WV |
NPI | 1023088770 |
---|---|
Provider Name | Dr. Christopher Blake Myers |
First Address | Bluefield, WV 24701-4562 |
Second Address | Bluefield, WV 24701-4562 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 03/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
140234 | (05) | SC |
1577695003 | CIGNA PROVIDER NUMBER (01) | SC |
180018442 | MEDICARE RAILROAD (01) | SC |
4328801 | AETNA PROVIDER NUMBER (01) | SC |
F20021 | (02) | SC |