Provider Demographics
NPI:1942598248
Name:CMEJLA, ANDREA (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:CMEJLA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:MOERCHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:15243 BEAM ST
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-4694
Mailing Address - Country:US
Mailing Address - Phone:317-908-1830
Mailing Address - Fax:
Practice Address - Street 1:160 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-1307
Practice Address - Country:US
Practice Address - Phone:317-773-4482
Practice Address - Fax:317-776-2520
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003678A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN232710Medicare PIN