Healthcare Provider Details

I. General information

NPI: 1134578461
Provider Name (Legal Business Name): SAMUEL JAMES MENEI O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 02/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 E MAIN ST
MIDDLETOWN DE
19709-1449
US

IV. Provider business mailing address

128 W FLAGSTONE DR
NEWARK DE
19702-3647
US

V. Phone/Fax

Practice location:
  • Phone: 302-376-4190
  • Fax: 302-376-5644
Mailing address:
  • Phone: 302-312-9725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG003188
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00667000
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberI3-0001393
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: