Ethan T Mengle, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT.006684 Issued in OH

Practice address

409 N Court St
Medina, OH 44256-1869

Phone

(330) 725-4680

Fax

(330) 633-7165

NPI assigned

May 30, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

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

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 and National Provider Directory roles.

• Clarkson Optometry Midwest Inc

  • Optometrist
  • Centerville, OH
  • NPI 1073917597
  Medicare reassignment NPD
• Clarkson Optometry Midwest Inc

  • Optometrist
  • West Chester, OH
  • NPI 1003348327
  NPD
• Opti-Vision

  • Optician
  • Hudson, OH
  • NPI 1831216605
  NPD (past)

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

{
    "created_epoch": "1527638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623110400000",
    "number": "1417449174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 207170",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753207173",
            "telephone_number": "636-200-4393",
            "fax_number": "636-527-0766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 N COURT ST",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442561869",
            "telephone_number": "330-725-4680",
            "fax_number": "330-633-7165"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1558 Akron Peninsula Rd",
            "address_purpose": "LOCATION",
            "city": "Akron",
            "state": "OH",
            "postal_code": "443135154",
            "country_code": "US",
            "telephone_number": "330-922-4040",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5697 Darrow Rd",
            "address_purpose": "LOCATION",
            "city": "Hudson",
            "state": "OH",
            "postal_code": "442364013",
            "country_code": "US",
            "telephone_number": "330-650-0919",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1155 State Route 303",
            "address_purpose": "LOCATION",
            "city": "Streetsboro",
            "state": "OH",
            "postal_code": "442413969",
            "country_code": "US",
            "telephone_number": "330-422-2020",
            "fax_number": "330-422-0316",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MENGLE",
        "first_name": "ETHAN",
        "middle_name": "T",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-30",
        "last_updated": "2021-06-08",
        "certification_date": "2021-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "OPT.006684",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cayley C Meindl
• Letitia Ann Mellert
• Emily Mellion, D.D.S.
• Stacey J.P. Memberg, MD
• Jennifer Mencke
• Amanda Kristen Mergy, CNP
• Christine Merriman
• Dena S Merriman, DPM
• Alexis Michelle Merritt
• John Franklin Messina, D.D.S.

• Optometrist in Medina, OH
• Providers in Medina, OH by specialty
• Optometrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2021; 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.