Provider Demographics
NPI:1508944562
Name:HOM, MELANIE LYNN (MD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:LYNN
Last Name:HOM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:491 30TH ST
Mailing Address - Street 2:SUITE #201
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3235
Mailing Address - Country:US
Mailing Address - Phone:510-836-2122
Mailing Address - Fax:510-836-3773
Practice Address - Street 1:491 30TH ST
Practice Address - Street 2:SUITE #201
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3235
Practice Address - Country:US
Practice Address - Phone:510-836-2122
Practice Address - Fax:510-836-3773
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA86406207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00435524OtherMEDICARE RAILROAD
CA00A864060Medicaid
P00435524OtherMEDICARE RAILROAD
6006360001Medicare NSC
CA00A864061Medicare PIN