MEDICARE: DR. CAROL FLEWELLEN MERRITT O.D.

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
1	152W00000X	Optometrist	TO2850	MO

General Provider Information

NPI Number	:	1063547735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROL FLEWELLEN MERRITT O.D.

Provider Business Mailing Address
First Line	:	4401 KAREN ANN CT
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63034-3496
Country	:	US
Telephone Number	:	314-831-0399
Fax Number	:

Provider Business Practice Location Address
First Line	:	45 BLACK JACK CT
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033-7101
Country	:	US
Telephone Number	:	314-653-2020
Fax Number	:	314-653-6299

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	07/08/2007

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