Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 227900 | NY |
N | 207W00000X | Ophthalmologist | 47874 | WI |
NPI | 1013984681 |
---|---|
Provider Name | Stephen W Merriam |
First Address | Syracuse, NY 13214-1847 |
Second Address | Syracuse, NY 13214-1847 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2006 |
Last Update Date | 27/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34628900 | (05) | WI |
I27790 | (02) |