Basic Information
| Provider Information | |||||||||
| NPI: | 1730644477 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEEK | ||||||||
| FirstName: | THEOTHOTA | ||||||||
| MiddleName: | BAIRAKTARIS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16800 W CLEVELAND AVE | ||||||||
| Address2: | |||||||||
| City: | NEW BERLIN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531513533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2624322005 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11340 N PT WASHINGTON RD | ||||||||
| Address2: | |||||||||
| City: | MEQUON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530923412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2622400455 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2019 | ||||||||
| LastUpdateDate: | 05/17/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 3540 | WI | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.