Provider Demographics
NPI:1255585378
Name:MEEKER-MUNIZ, ALYCIA MAE (OD)
Entity type:Individual
Prefix:
First Name:ALYCIA
Middle Name:MAE
Last Name:MEEKER-MUNIZ
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 1:1105 CRANDALL DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-4540
Mailing Address - Country:US
Mailing Address - Phone:971-275-2063
Mailing Address - Fax:
Practice Address - Street 1:4759 W. 29TH ST.
Practice Address - Street 2:UNIT C
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634
Practice Address - Country:US
Practice Address - Phone:970-339-0087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2686152W00000X
WY324T152W00000X
MT803152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist