Basic Information
| Provider Information | |||||||||
| NPI: | 1114019387 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEIER | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | LLOYD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1115 SW TAYLOR ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032270354 | ||||||||
| FaxNumber: | 5032741697 | ||||||||
| Practice Location | |||||||||
| Address1: | 1115 SW TAYLOR ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032270354 | ||||||||
| FaxNumber: | 5032741697 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 08/07/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | MD21730 | OR | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 134381 | 05 | OR | MEDICAID |