Brian L Meckelberg, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2056 Issued in WI

Practice address

N2577 Plaza Rd
Wautoma, WI 54982-7706

Phone

(920) 787-3837

Fax

(920) 787-1613

NPI assigned

Dec 19, 2005

Last updated

Jul 13, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wautoma Eye Clinic S.C.

  • Optometrist
  • Wautoma, WI
  • NPI 1972628584
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1134950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278979200000",
    "number": "1013993393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 366",
            "address_2": "N2577 PLAZA RD",
            "city": "WAUTOMA",
            "state": "WI",
            "postal_code": "549820366",
            "telephone_number": "920-787-3837",
            "fax_number": "920-787-1613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N2577 PLAZA RD",
            "city": "WAUTOMA",
            "state": "WI",
            "postal_code": "549827706",
            "telephone_number": "920-787-3837",
            "fax_number": "920-787-1613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MECKELBERG",
        "first_name": "BRIAN",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-19",
        "last_updated": "2010-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2056",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38525000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Howard J Lubin, D.D.S.
• Emily M Marshall, DPT
• Dianne L Martinez, PTA
• Cynthia Marie McMahon
• Karen E McQuown, DENTAL HYGIENIST
• Kayla Meilick, RDH
• John P. Modrzynski, M.D.
• Bonnie Sue Monaghan, RDH
• Virginia Ellen Moon, M.S.
• Toni Ann Morgan-Jones, PHD

• Optometrist in Wautoma, WI
• Providers in Wautoma, WI by specialty
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.