Provider Demographics
NPI:1134659782
Name:COLE, MELISSA NICOLE (OD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:NICOLE
Last Name:COLE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12538 108 RD
Mailing Address - Street 2:
Mailing Address - City:MINNEOLA
Mailing Address - State:KS
Mailing Address - Zip Code:67865-8503
Mailing Address - Country:US
Mailing Address - Phone:620-255-2562
Mailing Address - Fax:
Practice Address - Street 1:2520 N 14TH AVE
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801
Practice Address - Country:US
Practice Address - Phone:620-227-3071
Practice Address - Fax:620-227-6911
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2065152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist