Provider Demographics
NPI:1629203864
Name:NICOLE L. MEERPOHL, OD
Entity Type:Organization
Organization Name:NICOLE L. MEERPOHL, OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MEERPOHL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:785-364-4183
Mailing Address - Street 1:111 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLTON
Mailing Address - State:KS
Mailing Address - Zip Code:66436-1701
Mailing Address - Country:US
Mailing Address - Phone:785-364-4183
Mailing Address - Fax:785-364-2088
Practice Address - Street 1:111 W 4TH ST
Practice Address - Street 2:
Practice Address - City:HOLTON
Practice Address - State:KS
Practice Address - Zip Code:66436-1701
Practice Address - Country:US
Practice Address - Phone:785-364-4183
Practice Address - Fax:785-364-2088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1556152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100363080CMedicaid
KS100363080CMedicaid