Provider Demographics
NPI:1285201988
Name:WURSTER, MEITAL (OD)
Entity Type:Individual
Prefix:
First Name:MEITAL
Middle Name:
Last Name:WURSTER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MEITAL
Other - Middle Name:
Other - Last Name:SHACHAF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1221 S CREASY LN STE A
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-7430
Mailing Address - Country:US
Mailing Address - Phone:765-447-4951
Mailing Address - Fax:
Practice Address - Street 1:1221 S CREASY LN STE A
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-7430
Practice Address - Country:US
Practice Address - Phone:765-447-4951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004265A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty