Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | G39669 | CA |
NPI | 1003185836 |
---|---|
Provider Name | Kenneth Meyer |
First Address | Chester, CA 96020-9737 |
Second Address | Chester, CA 96020-9737 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2011 |
Last Update Date | 23/12/2011 |