Individual provider Active NPI

Mark Rolland Myers, O.D.

  • Optometrist
  • Pikeville, KY
National Provider Identifier
1639117443
Registry record updated Jan 15, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
966DT Issued in KY
Practice address
109 Caroline Ave
Pikeville, KY 41501-1101
Phone
(606) 437-7587
Fax
(606) 437-7035
NPI assigned
Jun 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 966DT KY Primary

Addresses

Primary practice location

109 Caroline Ave
Pikeville, KY 41501-1101

Mailing address

109 Caroline Ave
Pikeville, KY 41501-1101
Phone (606) 437-7587

Other identifiers 1

IdentifierTypeStateIssuer
77009660MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0966KYMDProfessional Counselor
966DTKYMDOptometrist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1231977600000",
    "number": "1639117443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 CAROLINE AVE",
            "city": "PIKEVILLE",
            "state": "KY",
            "postal_code": "415011101",
            "telephone_number": "606-437-7587",
            "fax_number": "606-437-7035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 CAROLINE AVE",
            "city": "PIKEVILLE",
            "state": "KY",
            "postal_code": "415011101",
            "telephone_number": "606-437-7587",
            "fax_number": "606-437-7035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYERS",
        "first_name": "MARK",
        "middle_name": "ROLLAND",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-03",
        "last_updated": "2009-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "966DT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "77009660",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pikeville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.