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General NPI Number Information
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NPI Number | 1144486614
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Entity Type | Organization
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Legal Business Name | CHARLES KENT MENG O D LTD
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Dates
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Enumeration Date | 08/04/2008
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Last Update Date | 10/01/2008
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Provider Practice Location Address
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Address Line | 2900 S WISCONSIN AVE
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City | RICE LAKE
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State | WI
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Zip | 54868-8578
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Country | US
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Telephone | 715-234-2787
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Fax | 715-234-8920
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Provider Business Mailing Address
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Address Line | 2900 S WISCONSIN AVE
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City | RICE LAKE
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State | WI
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Zip | 54868-8578
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Country | US
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Telephone | 715-234-2787
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Fax | 715-234-8920
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. CHARLES KENT MENG
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Credential | O.D.
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Telephone | 715-234-1787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 01449
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License Number State | WI
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