Provider Demographics
NPI:1326248931
Name:OLTZ, MELISSA CLARE (OD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:CLARE
Last Name:OLTZ
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 1:100 UPTOWN RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1632
Mailing Address - Country:US
Mailing Address - Phone:607-257-5599
Mailing Address - Fax:
Practice Address - Street 1:100 UPTOWN RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1632
Practice Address - Country:US
Practice Address - Phone:607-257-5599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-21
Last Update Date:2008-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001938152W00000X
NYTUV007205-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist