Provider Demographics
NPI:1780690529
Name:MEERPOHL, NICOLE L (OD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:L
Last Name:MEERPOHL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLTON
Mailing Address - State:KS
Mailing Address - Zip Code:66436-1701
Mailing Address - Country:US
Mailing Address - Phone:785-364-4183
Mailing Address - Fax:785-364-2088
Practice Address - Street 1:111 W 4TH ST
Practice Address - Street 2:
Practice Address - City:HOLTON
Practice Address - State:KS
Practice Address - Zip Code:66436-1701
Practice Address - Country:US
Practice Address - Phone:785-364-4183
Practice Address - Fax:785-364-2088
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1556152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100363080AMedicaid
KS4070870001Medicare NSC
KS100363080AMedicaid
KS650726Medicare ID - Type Unspecified