Provider Demographics
NPI:1356657829
Name:MELISSA K PLOWMAKER,OD PC
Entity Type:Organization
Organization Name:MELISSA K PLOWMAKER,OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:K
Authorized Official - Last Name:PLOWMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:717-721-6686
Mailing Address - Street 1:890 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-2562
Mailing Address - Country:US
Mailing Address - Phone:717-721-6686
Mailing Address - Fax:717-738-7735
Practice Address - Street 1:890 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-2562
Practice Address - Country:US
Practice Address - Phone:717-721-6686
Practice Address - Fax:717-738-7735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000544152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017436550001Medicaid
PA892907Medicare PIN
PAU63324Medicare UPIN