Individual provider Active NPI

Mariannette J Miller-Meeks, M.D.

  • Ophthalmology Physician
  • West Burlington, IA
National Provider Identifier
1124020722
Registry record updated Feb 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
26438 Issued in IA
Practice address
1223 S Gear Ave
Suite 309
West Burlington, IA 52655-1682
Phone
(319) 768-4500
Fax
(319) 768-4505
NPI assigned
Aug 12, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 26438 IA Primary

Addresses

Primary practice location

1223 S Gear Ave
Suite 309
West Burlington, IA 52655-1682

Mailing address

1223 S Gear Ave
Suite 309
West Burlington, IA 52655-1682
Phone (319) 768-4500

Other identifiers 2

IdentifierTypeStateIssuer
3116202MedicaidIA
421479101OtherIATAX ID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
26438IAMDOphthalmology Physician

NPI Registry JSON

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

{
    "created_epoch": "1123804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454371200000",
    "number": "1124020722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1223 S GEAR AVE",
            "address_2": "SUITE 309",
            "city": "WEST BURLINGTON",
            "state": "IA",
            "postal_code": "526551682",
            "telephone_number": "319-768-4500",
            "fax_number": "319-768-4505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1223 S GEAR AVE",
            "address_2": "SUITE 309",
            "city": "WEST BURLINGTON",
            "state": "IA",
            "postal_code": "526551682",
            "telephone_number": "319-768-4500",
            "fax_number": "319-768-4505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER-MEEKS",
        "first_name": "MARIANNETTE",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-12",
        "last_updated": "2016-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "IA",
            "license": "26438",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3116202",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "421479101",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Burlington, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.