Provider Demographics
NPI:1003955444
Name:FELICIANO, MELANIE (OD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:FELICIANO
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 1:1098 FOSTER CITY BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-2300
Mailing Address - Country:US
Mailing Address - Phone:650-345-2020
Mailing Address - Fax:650-345-2022
Practice Address - Street 1:1098 FOSTER CITY BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-2300
Practice Address - Country:US
Practice Address - Phone:650-345-2020
Practice Address - Fax:650-345-2022
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12572T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist