Provider Demographics
NPI:1730100637
Name:JOPLIN OPHTHALMOLOGY -W R MEREDI
Entity Type:Organization
Organization Name:JOPLIN OPHTHALMOLOGY -W R MEREDI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MEREDITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-782-2020
Mailing Address - Street 1:2216 E 32ND ST
Mailing Address - Street 2:STE. 202
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-3016
Mailing Address - Country:US
Mailing Address - Phone:417-782-2020
Mailing Address - Fax:417-782-7861
Practice Address - Street 1:2216 E 32ND ST
Practice Address - Street 2:STE. 202
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3016
Practice Address - Country:US
Practice Address - Phone:417-782-2020
Practice Address - Fax:417-782-7861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7952207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100257110AMedicaid
MO200024008Medicaid
KS100257110AMedicaid
MO200024008Medicaid