Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 113170-9934 | UT |
Y | 152W00000X | Optometrist | OPT8803TPA | CA |
NPI | 1003087693 |
---|---|
Provider Name | Dr. Jerald Brent Meek |
First Address | Paso Robles, CA 93446-2528 |
Second Address | Paso Robles, CA 93446-2528 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2008 |
Last Update Date | 04/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
SD0088030 | (05) | CA |
W22070 | (02) | CA |