Provider Demographics
NPI:1841502762
Name:NIEMEIER, MINDY KAY (OD)
Entity type:Individual
Prefix:DR
First Name:MINDY
Middle Name:KAY
Last Name:NIEMEIER
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 1:1685 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:HOLTS SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:65043-1407
Mailing Address - Country:US
Mailing Address - Phone:573-291-3896
Mailing Address - Fax:
Practice Address - Street 1:415 CONLEY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6468
Practice Address - Country:US
Practice Address - Phone:573-499-1945
Practice Address - Fax:573-499-1943
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010021802152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist