Provider Demographics
NPI:1033130554
Name:KUNTZ, MELISSA MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:MARIE
Last Name:KUNTZ
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 1:2510 MAPLE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-1807
Mailing Address - Country:US
Mailing Address - Phone:218-722-2712
Mailing Address - Fax:
Practice Address - Street 1:2510 MAPLE GROVE RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-1807
Practice Address - Country:US
Practice Address - Phone:218-722-2712
Practice Address - Fax:218-722-2712
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13052152W00000X
WI3092-035152W00000X
MN3072152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist