Provider Demographics
NPI:1114587946
Name:DR MELISSA WALTERS OPTOMETRIST PLLC
Entity Type:Organization
Organization Name:DR MELISSA WALTERS OPTOMETRIST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:607-333-1633
Mailing Address - Street 1:123 WOOLF LN
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-9551
Mailing Address - Country:US
Mailing Address - Phone:607-333-1633
Mailing Address - Fax:607-241-9951
Practice Address - Street 1:2230 N TRIPHAMMER RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-6513
Practice Address - Country:US
Practice Address - Phone:607-391-0343
Practice Address - Fax:607-241-9951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-14
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty