MEDICARE: MARY TERESE MEERNIK 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	4901002862	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417135922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY TERESE MEERNIK O.D.

Provider Business Mailing Address
First Line	:	872 MUNSON AVE
Second Line	:	SUITE B
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-3638
Country	:	US
Telephone Number	:	231-947-1690
Fax Number	:	231-947-1692

Provider Business Practice Location Address
First Line	:	872 MUNSON AVE
Second Line	:	SUITE B
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-3638
Country	:	US
Telephone Number	:	231-947-1690
Fax Number	:	231-947-1692

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

Provider Enumeration Date	:	02/06/2008
Last Update Date	:	01/22/2016

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