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NPI Code Detail

MEDICARE: MARK R MEULER OD

MEDICARE: MARK R MEULER OD
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
1152W00000XOptometrist1889WI

General Provider Information

NPI Number : 1811980568
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK R MEULER OD
Provider Business Mailing Address
First Line : 1700 W PARADISE DR
Second Line :
City : WEST BEND
State : WI
Zip : 53095-9795
Country : US
Telephone Number : 262-334-3451
Fax Number :
Provider Business Practice Location Address
First Line : 1700 W PARADISE DR
Second Line :
City : WEST BEND
State : WI
Zip : 53095-9795
Country : US
Telephone Number : 262-334-3451
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2005
Last Update Date : 04/01/2013

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