Provider Demographics
NPI:1780637496
Name:MERCKLE, STEPHEN J (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:MERCKLE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:220 SOUTHTOWN CIR
Mailing Address - Street 2:
Mailing Address - City:ROLESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27571-9593
Mailing Address - Country:US
Mailing Address - Phone:919-554-2440
Mailing Address - Fax:919-554-1571
Practice Address - Street 1:220 SOUTHTOWN CIR
Practice Address - Street 2:
Practice Address - City:ROLESVILLE
Practice Address - State:NC
Practice Address - Zip Code:27571-9593
Practice Address - Country:US
Practice Address - Phone:919-554-2440
Practice Address - Fax:919-554-1571
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1833152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89093KEMedicaid
NC89093KEMedicaid