Provider Demographics
NPI:1184675746
Name:LEONI, MELISSA LOUISE (OD)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:LOUISE
Last Name:LEONI
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 1:6010 US ROUTE 60 E
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-1029
Mailing Address - Country:US
Mailing Address - Phone:304-733-0809
Mailing Address - Fax:304-733-4234
Practice Address - Street 1:6010 US ROUTE 60 E
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1029
Practice Address - Country:US
Practice Address - Phone:304-733-0809
Practice Address - Fax:304-733-4234
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV103200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001709447OtherBLUE CROSS
9354451Medicare ID - Type Unspecified
WV001709447OtherBLUE CROSS