Provider Demographics
NPI:1144486614
Name:CHARLES KENT MENG O D LTD
Entity type:Organization
Organization Name:CHARLES KENT MENG O D LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:MENG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:715-234-1787
Mailing Address - Street 1:2900 S WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-8578
Mailing Address - Country:US
Mailing Address - Phone:715-234-2787
Mailing Address - Fax:715-234-8920
Practice Address - Street 1:2900 S WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-8578
Practice Address - Country:US
Practice Address - Phone:715-234-2787
Practice Address - Fax:715-234-8920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI01449332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0537230001Medicare NSC
WI000087535Medicare PIN