Provider Demographics
NPI:1033826524
Name:MERRIMAN OPTOMETRY, LTD
Entity type:Organization
Organization Name:MERRIMAN OPTOMETRY, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CELISHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MERRIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:618-697-4673
Mailing Address - Street 1:103 TRANSCRAFT DR
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:IL
Mailing Address - Zip Code:62906-2114
Mailing Address - Country:US
Mailing Address - Phone:618-833-3777
Mailing Address - Fax:618-614-1414
Practice Address - Street 1:103 TRANSCRAFT DR
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:IL
Practice Address - Zip Code:62906-2114
Practice Address - Country:US
Practice Address - Phone:618-833-3777
Practice Address - Fax:618-614-1414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-03
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty