Provider Demographics
NPI:1215005384
Name:WOLTER, MELINDA MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:MARIE
Last Name:WOLTER
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 1:75 HOCKANUM BLVD
Mailing Address - Street 2:SUITE #933
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4056
Mailing Address - Country:US
Mailing Address - Phone:860-871-2510
Mailing Address - Fax:860-871-2510
Practice Address - Street 1:791 HARTFORD PIKE
Practice Address - Street 2:
Practice Address - City:DAYVILLE
Practice Address - State:CT
Practice Address - Zip Code:06241-1715
Practice Address - Country:US
Practice Address - Phone:860-779-6123
Practice Address - Fax:860-779-8655
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002646152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT026460OtherCONNECTICARE PROVIDER ID#
900733OtherEYEMED
7164708OtherCIGNA PPO ID#
P3641716OtherOXFORD
2559577OtherUNITEDHEALTHCARE
090002646CT03OtherANTHEM BCBS ID# ENFIELD
090002646CT01OtherANTHEM BCBS ID# DAYVILLE
090002646CT03OtherANTHEM BCBS ID# ENFIELD
900733OtherEYEMED