Provider Demographics
NPI:1588019434
Name:ELINE, MELISSA SMITH (OD)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:SMITH
Last Name:ELINE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:SUE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1880 KENNETH RD STE 1
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17408-6344
Mailing Address - Country:US
Mailing Address - Phone:717-767-2000
Mailing Address - Fax:717-767-2013
Practice Address - Street 1:1880 KENNETH RD STE 1
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17408-6344
Practice Address - Country:US
Practice Address - Phone:717-767-2000
Practice Address - Fax:717-767-2013
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-28
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2487152W00000X
FLOPC005129152W00000X
PAOEG003213152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist