Provider Demographics
NPI:1902929391
Name:MEACHAM, LOIS MARGARET (OD)
Entity Type:Individual
Prefix:DR
First Name:LOIS
Middle Name:MARGARET
Last Name:MEACHAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:CIRCLE PINES
Mailing Address - State:MN
Mailing Address - Zip Code:55014-0488
Mailing Address - Country:US
Mailing Address - Phone:651-784-3375
Mailing Address - Fax:651-784-3382
Practice Address - Street 1:749 APOLLO DR
Practice Address - Street 2:
Practice Address - City:LINO LAKES
Practice Address - State:MN
Practice Address - Zip Code:55014-3035
Practice Address - Country:US
Practice Address - Phone:651-784-7625
Practice Address - Fax:651-784-7627
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN2566152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist