Meckelberg, Brian L
Meckelberg, Brian L is an sole proprietor health care provider with primary practice located at N2577 Plaza Rd , Wautoma WI 54982-7706. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Meckelberg, Brian L can be contacted via phone (920) 787-3837.Contact Information
Primary practice address
N2577 Plaza Rd
Wautoma WI 54982-7706
Phone: (920) 787-3837
Fax: (920) 787-1613
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 2056 | Wisconsin |
Profile Details
| NPI number | 1013993393 |
|---|---|
| LBN Legal business name | Meckelberg, Brian L |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Dec 19th, 2005 |
| Last updated | Jul 13th, 2010 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1013993393 | NPPES |
| Wisconsin | MEDICAID | 38525000 |
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