Provider Demographics
NPI:1750477048
Name:MEUSER, LONNIE ROBERT (CO1444)
Entity Type:Individual
Prefix:MR
First Name:LONNIE
Middle Name:ROBERT
Last Name:MEUSER
Suffix:
Gender:M
Credentials:CO1444
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 OAK ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-2365
Mailing Address - Country:US
Mailing Address - Phone:217-443-9525
Mailing Address - Fax:217-554-4845
Practice Address - Street 1:1900 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-5100
Practice Address - Country:US
Practice Address - Phone:217-554-5218
Practice Address - Fax:217-554-4845
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILV130213OtherORTHOTIST