Healthcare Provider Details

I. General information

NPI: 1124020722
Provider Name (Legal Business Name): MARIANNETTE J MILLER-MEEKS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 S GEAR AVE SUITE 309
WEST BURLINGTON IA
52655-1682
US

IV. Provider business mailing address

1223 S GEAR AVE SUITE 309
WEST BURLINGTON IA
52655-1682
US

V. Phone/Fax

Practice location:
  • Phone: 319-768-4500
  • Fax: 319-768-4505
Mailing address:
  • Phone: 319-768-4500
  • Fax: 319-768-4505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number26438
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: