Basic Information
| Provider Information | |||||||||
| NPI: | 1861522054 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MYERS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1939 E BURNSIDE ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972141535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032336141 | ||||||||
| FaxNumber: | 5032332889 | ||||||||
| Practice Location | |||||||||
| Address1: | 7722 NE HAZEL DELL AVE | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986658225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602602898 | ||||||||
| FaxNumber: | 3606969517 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | 237700000X | HA00002422 | WA | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 237700000X | HAS-P-10111794 | OR | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
ID Information
| ID | Type | State | Issuer | Description | 2432417000 | 01 | FEDERAL WORKERS COMP | OTHER | 0162102 | 01 | WA | WORKERS COMP | OTHER | 212936 | 05 | OR | MEDICAID | 9178104 | 05 | WA | MEDICAID |