1568918225 NPI number — MRS. ISABELLA SAMANTHA MYERS O.D.

Table of content: MRS. ISABELLA SAMANTHA MYERS O.D. (NPI 1568918225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568918225 NPI number — MRS. ISABELLA SAMANTHA MYERS O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MYERS
Provider First Name:
ISABELLA
Provider Middle Name:
SAMANTHA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DIAZ
Provider Other First Name:
ISABELLA
Provider Other Middle Name:
SAMANTHA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1568918225
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 DOTS CIRCLE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLISTER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95023-6313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-607-3990
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8050 SANTA TERESA BLVD
Provider Second Line Business Practice Location Address:
#110
Provider Business Practice Location Address City Name:
GILROY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95020-3862
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-842-2020
Provider Business Practice Location Address Fax Number:
408-842-0312
Provider Enumeration Date:
08/31/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  33538 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 33538TLG , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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