Provider Demographics
NPI:1699141598
Name:MUELLER, MEREDITH LANHAM (OD)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:LANHAM
Last Name:MUELLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:BROOKE
Other - Last Name:LANHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1935 BLUEGRASS AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-1181
Mailing Address - Country:US
Mailing Address - Phone:502-364-0033
Mailing Address - Fax:502-361-4488
Practice Address - Street 1:4010 DUPONT CIR
Practice Address - Street 2:SUITE 380
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4812
Practice Address - Country:US
Practice Address - Phone:502-895-0040
Practice Address - Fax:502-361-4488
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1987DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201357420Medicaid
KY7100424490Medicaid