Provider Demographics
NPI:1154326940
Name:MEKEL, EDWARD (OD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:MEKEL
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 1:2010 WEST CHESTER PIKE
Mailing Address - Street 2:WELLNESS CENTER; SUITE 310
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-2737
Mailing Address - Country:US
Mailing Address - Phone:610-446-2260
Mailing Address - Fax:610-446-3360
Practice Address - Street 1:2010 WEST CHESTER PIKE
Practice Address - Street 2:WELLNESS CENTER; SUITE 310
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-2737
Practice Address - Country:US
Practice Address - Phone:610-446-2260
Practice Address - Fax:610-446-3360
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000829152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA410039514OtherRAILROAD MEDICARE
PA410039514OtherRAILROAD MEDICARE
PA410626YG9SMedicare PIN
PA410626K3SMedicare PIN