Provider Demographics
NPI:1326562794
Name:MENG, MELISSA LAU (OD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LAU
Last Name:MENG
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 1:6037 TOURRAINE DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-1738
Mailing Address - Country:US
Mailing Address - Phone:510-304-7879
Mailing Address - Fax:
Practice Address - Street 1:1183 S DE ANZA BLVD STE 50
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-3659
Practice Address - Country:US
Practice Address - Phone:408-366-1681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-27
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT33692152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist