Provider Demographics
NPI:1942366240
Name:MEYER, KELLEE D (OD)
Entity Type:Individual
Prefix:DR
First Name:KELLEE
Middle Name:D
Last Name:MEYER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2848 PARK AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-3375
Mailing Address - Country:US
Mailing Address - Phone:209-383-1408
Mailing Address - Fax:209-383-3836
Practice Address - Street 1:2848 PARK AVE STE A
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-3375
Practice Address - Country:US
Practice Address - Phone:209-383-1408
Practice Address - Fax:209-383-3836
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9052T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT90119Medicare UPIN