Provider Demographics
NPI:1770654345
Name:J BRENT MEEK O D INC
Entity Type:Organization
Organization Name:J BRENT MEEK O D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERALD
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:MEEK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:805-238-4460
Mailing Address - Street 1:1034 VINE ST
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-2528
Mailing Address - Country:US
Mailing Address - Phone:805-238-4460
Mailing Address - Fax:805-238-1715
Practice Address - Street 1:1034 VINE ST
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-2528
Practice Address - Country:US
Practice Address - Phone:805-238-4460
Practice Address - Fax:805-238-1715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0088030Medicaid
CAWOP8803AMedicare PIN
CASD0088030Medicaid
CA1185350001Medicare NSC