Provider Demographics
NPI:1306838958
Name:PICKEL JR, MERLE K (OD)
Entity type:Individual
Prefix:
First Name:MERLE
Middle Name:K
Last Name:PICKEL JR
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 1:50 WILLOW ST STE A
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47448-7063
Mailing Address - Country:US
Mailing Address - Phone:812-988-4937
Mailing Address - Fax:812-988-2110
Practice Address - Street 1:50 WILLOW ST
Practice Address - Street 2:SUITE A
Practice Address - City:NASHVILLE
Practice Address - State:IN
Practice Address - Zip Code:47448-7013
Practice Address - Country:US
Practice Address - Phone:812-988-4937
Practice Address - Fax:812-988-2110
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001529B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN410005190OtherRAILROAD MEDICARE
IN100066500AMedicaid
IN000000083711OtherANTHEM
IN410005190OtherRAILROAD MEDICARE
IN090190Medicare ID - Type Unspecified
IN100066500AMedicaid