Healthcare Provider Details

I. General information

NPI: 1043418437
Provider Name (Legal Business Name): RACHEL ELAINE MERRIMAN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 12/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 PROFESSIONAL PKWY
TROY MO
63379-2822
US

IV. Provider business mailing address

84 PROFESSIONAL PKWY
TROY MO
63379-2822
US

V. Phone/Fax

Practice location:
  • Phone: 636-528-6104
  • Fax:
Mailing address:
  • Phone: 636-528-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2007018531
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: