Provider Demographics
NPI:1518306539
Name:MERRICKS, STEPHEN E (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:E
Last Name:MERRICKS
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3405 BRAMBLETON AVE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-6519
Mailing Address - Country:US
Mailing Address - Phone:540-344-2020
Mailing Address - Fax:540-777-1125
Practice Address - Street 1:3405 BRAMBLETON AVE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-6519
Practice Address - Country:US
Practice Address - Phone:540-344-2020
Practice Address - Fax:540-777-1125
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician