Individual
DR. BRIAN L MECKELBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
N2577 PLAZA RD, WAUTOMA, WI 54982-7706
(920) 787-3837
(920) 787-1613
Mailing address
PO BOX 366, N2577 PLAZA RD, WAUTOMA, WI 54982-0366
(920) 787-3837
(920) 787-1613
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2056
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38525000
—
WI
Enumeration date
12/19/2005
Last updated
07/13/2010
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