Provider Demographics
NPI:1568039568
Name:MEHRL, KASSANDRA ROSE (OD)
Entity type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:ROSE
Last Name:MEHRL
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 1:8822 CANYON ST
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8538
Mailing Address - Country:US
Mailing Address - Phone:515-491-5212
Mailing Address - Fax:
Practice Address - Street 1:1905 EP TRUE PKWY # 103
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-7056
Practice Address - Country:US
Practice Address - Phone:515-225-0877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA109012152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist