Provider Demographics
NPI:1467682930
Name:JANSEN, MEREDITH ELAINE (OD)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:ELAINE
Last Name:JANSEN
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:1274 S COLLEGE MALL RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-6185
Mailing Address - Country:US
Mailing Address - Phone:812-454-1605
Mailing Address - Fax:812-855-5417
Practice Address - Street 1:800 E ATWATER AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47405-3635
Practice Address - Country:US
Practice Address - Phone:812-855-3986
Practice Address - Fax:812-855-5417
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN18003585A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist