Basic Information
Provider Information | |||||||||
NPI: | 1134578461 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MENEI | ||||||||
FirstName: | SAMUEL | ||||||||
MiddleName: | JAMES | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | O.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 128 W FLAGSTONE DR | ||||||||
Address2: |   | ||||||||
City: | NEWARK | ||||||||
State: | DE | ||||||||
PostalCode: | 197023647 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3023129725 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 223 E MAIN ST | ||||||||
Address2: |   | ||||||||
City: | MIDDLETOWN | ||||||||
State: | DE | ||||||||
PostalCode: | 197091449 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3023764190 | ||||||||
FaxNumber: | 3023765644 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/07/2016 | ||||||||
LastUpdateDate: | 02/27/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OEG003188 | PA | N |   | Eye and Vision Services Providers | Optometrist |   | 152W00000X | 27OA00667000 | NJ | N |   | Eye and Vision Services Providers | Optometrist |   | 152W00000X | I3-0001393 | DE | Y |   | Eye and Vision Services Providers | Optometrist |   |
No ID Information.