Provider Demographics
NPI:1558353466
Name:MERCER, MELISSA V (OD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:V
Last Name:MERCER
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 1:5885 GUNN HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-4007
Mailing Address - Country:US
Mailing Address - Phone:813-908-0100
Mailing Address - Fax:813-908-0099
Practice Address - Street 1:5885 GUNN HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-4007
Practice Address - Country:US
Practice Address - Phone:813-908-0100
Practice Address - Fax:813-908-0099
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3524152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU820920001Medicare UPIN
FL20942ZMedicare ID - Type Unspecified
FL1246560001Medicare NSC