Provider Demographics
NPI:1053455006
Name:WEINSTEIN, MELINDA S (OD)
Entity Type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:S
Last Name:WEINSTEIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1215 ANNAPOLIS RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1344
Mailing Address - Country:US
Mailing Address - Phone:410-672-2515
Mailing Address - Fax:301-912-2601
Practice Address - Street 1:1215 ANNAPOLIS RD
Practice Address - Street 2:SUITE 103
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1344
Practice Address - Country:US
Practice Address - Phone:410-672-2515
Practice Address - Fax:301-912-2601
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2008-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1089152W00000X
VA0601001738152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG02089W02Medicare PIN
MD309L673BMedicare PIN
MDU27888Medicare UPIN