Provider Demographics
NPI:1063662344
Name:STICKELBERGER, EMILY MEIHAK (OD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MEIHAK
Last Name:STICKELBERGER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1328 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-3912
Mailing Address - Country:US
Mailing Address - Phone:307-259-7523
Mailing Address - Fax:
Practice Address - Street 1:204 S DURBIN ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2562
Practice Address - Country:US
Practice Address - Phone:307-235-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2668152W00000X
WY406T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist