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NPI Code Detail

MEDICARE: DR. MICHAEL MATTHEW MERLENBACH O.D.

MEDICARE: DR. MICHAEL MATTHEW MERLENBACH O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist2000169300MO

General Provider Information

NPI Number : 1578506796
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL MATTHEW MERLENBACH O.D.
Provider Business Mailing Address
First Line : 2757 WHITECREEK LN
Second Line :
City : IMPERIAL
State : MO
Zip : 63052-4358
Country : US
Telephone Number : 636-461-2268
Fax Number :
Provider Business Practice Location Address
First Line : 1900 MAPLEWOOD COMMONS DR
Second Line : MERLENBACH EYECARE, P.C.
City : MAPLEWOOD
State : MO
Zip : 63143-1005
Country : US
Telephone Number : 314-781-1734
Fax Number : 314-781-0056
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2006
Last Update Date : 07/08/2007

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