Provider Demographics
NPI:1700869328
Name:MEIFERT, MICHAEL ARTHUR (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ARTHUR
Last Name:MEIFERT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3919 HIGHKNOB CIR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8247
Mailing Address - Country:US
Mailing Address - Phone:630-904-1053
Mailing Address - Fax:
Practice Address - Street 1:209 S LASALLE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-1219
Practice Address - Country:US
Practice Address - Phone:312-332-4461
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU82297Medicare UPIN