Provider Demographics
NPI:1437760089
Name:DACANAY, MELANIE (OD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:
Last Name:DACANAY
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 1:424 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-1129
Mailing Address - Country:US
Mailing Address - Phone:707-451-4437
Mailing Address - Fax:
Practice Address - Street 1:874 SOUTHAMPTON RD
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-1907
Practice Address - Country:US
Practice Address - Phone:707-745-6266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-16
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34654152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist