Provider Demographics
NPI:1033123625
Name:KRESSLEY, MELISSA C (OD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:C
Last Name:KRESSLEY
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 1:400 BROAD ST
Mailing Address - Street 2:SUITE 2020
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-1500
Mailing Address - Country:US
Mailing Address - Phone:412-741-4610
Mailing Address - Fax:412-741-8967
Practice Address - Street 1:400 BROAD ST
Practice Address - Street 2:SUITE 2020
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-1500
Practice Address - Country:US
Practice Address - Phone:412-741-4610
Practice Address - Fax:412-741-8967
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001579152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101216180Medicaid
PA089781Medicare ID - Type Unspecified
PA101216180Medicaid