Provider Demographics
NPI:1619947900
Name:MERSCH, DANIEL E (OD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:MERSCH
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:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:IA
Mailing Address - Zip Code:52057-0217
Mailing Address - Country:US
Mailing Address - Phone:563-927-3682
Mailing Address - Fax:563-927-6397
Practice Address - Street 1:1214 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:IA
Practice Address - Zip Code:52057-2305
Practice Address - Country:US
Practice Address - Phone:563-927-3682
Practice Address - Fax:563-927-6397
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02014152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0101048Medicaid
IA12969OtherWELLMARK
IA235466OtherMIDLANDS CHOICE
IA73206OtherCOVENTRY
IAI14796Medicare PIN
IA235466OtherMIDLANDS CHOICE
IA73206OtherCOVENTRY