Provider Demographics
NPI:1003087693
Name:MEEK, JERALD BRENT (OD)
Entity Type:Individual
Prefix:DR
First Name:JERALD
Middle Name:BRENT
Last Name:MEEK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 VINE ST
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-2528
Mailing Address - Country:US
Mailing Address - Phone:805-238-4460
Mailing Address - Fax:805-238-1715
Practice Address - Street 1:1034 VINE ST
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-2528
Practice Address - Country:US
Practice Address - Phone:805-238-4460
Practice Address - Fax:805-238-1715
Is Sole Proprietor?:No
Enumeration Date:2008-03-21
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT8803TPA152W00000X
UT113170-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0088030Medicaid
CAWOP8803AMedicare PIN
CAW22070Medicare UPIN
CASD0088030Medicaid