Provider Demographics
NPI:1558498949
Name:MERKLE, KAREN (OD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:MERKLE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 S 76TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53220-2320
Mailing Address - Country:US
Mailing Address - Phone:414-543-2900
Mailing Address - Fax:414-543-9130
Practice Address - Street 1:3925 S 76TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53220-2320
Practice Address - Country:US
Practice Address - Phone:414-543-2900
Practice Address - Fax:414-543-9130
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1595152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38514800Medicaid
WI1134280001Medicare ID - Type Unspecified
WI38514800Medicaid