Provider Demographics
NPI:1689880767
Name:MERLENBACH OPTOMETRY, P.C.
Entity Type:Organization
Organization Name:MERLENBACH OPTOMETRY, P.C.
Other - Org Name:MERLENBACH EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:MERLENBACH
Authorized Official - Suffix:SR
Authorized Official - Credentials:OD
Authorized Official - Phone:314-781-1734
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:314-781-1734
Mailing Address - Fax:314-781-0056
Practice Address - Street 1:1900 MAPLEWOOD COMMONS DR
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000169300152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty