Provider Demographics
NPI:1326486358
Name:MEINEL, BETSY L (OD)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:L
Last Name:MEINEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:L
Other - Last Name:BERENDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:309 E BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54451-1835
Mailing Address - Country:US
Mailing Address - Phone:715-748-2020
Mailing Address - Fax:715-748-4565
Practice Address - Street 1:309 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:WI
Practice Address - Zip Code:54451-1835
Practice Address - Country:US
Practice Address - Phone:715-748-2020
Practice Address - Fax:715-748-4565
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3299-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist