Provider Demographics
NPI:1306220785
Name:OCHLAN, MELISSA (OD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:OCHLAN
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 1:357 BUCHANAN AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4107
Mailing Address - Country:US
Mailing Address - Phone:646-423-2781
Mailing Address - Fax:
Practice Address - Street 1:1430 MAIN AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2146
Practice Address - Country:US
Practice Address - Phone:646-423-2781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-15
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00660600152W00000X
NY56008349152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1306220785Medicaid
NJ1306220785Medicaid