Provider Demographics
NPI:1407291248
Name:MELISSA M DAVID OD PLLC
Entity Type:Organization
Organization Name:MELISSA M DAVID OD PLLC
Other - Org Name:NEW VISION FAMILY EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:989-362-3478
Mailing Address - Street 1:PO BOX 509
Mailing Address - Street 2:
Mailing Address - City:EAST TAWAS
Mailing Address - State:MI
Mailing Address - Zip Code:48730-0509
Mailing Address - Country:US
Mailing Address - Phone:989-362-3478
Mailing Address - Fax:989-632-2380
Practice Address - Street 1:1704 E US 23
Practice Address - Street 2:
Practice Address - City:EAST TAWAS
Practice Address - State:MI
Practice Address - Zip Code:48730-9329
Practice Address - Country:US
Practice Address - Phone:989-362-3478
Practice Address - Fax:989-362-2380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-07
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA78869Medicare UPIN