Provider Demographics
NPI:1578506796
Name:MERLENBACH, MICHAEL MATTHEW (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MATTHEW
Last Name:MERLENBACH
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 1:2757 WHITECREEK LN
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:MO
Mailing Address - Zip Code:63052-4358
Mailing Address - Country:US
Mailing Address - Phone:636-461-2268
Mailing Address - Fax:
Practice Address - Street 1:1900 MAPLEWOOD COMMONS DR
Practice Address - Street 2:MERLENBACH EYECARE, P.C.
Practice Address - City:MAPLEWOOD
Practice Address - State:MO
Practice Address - Zip Code:63143-1005
Practice Address - Country:US
Practice Address - Phone:314-781-1734
Practice Address - Fax:314-781-0056
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000169300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU81952Medicare ID - Type Unspecified