Provider Demographics
NPI:1598758393
Name:ALMARALES, MELISSA SUE (OD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:SUE
Last Name:ALMARALES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:SUE
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1130 WASHINGTON ST
Mailing Address - Street 2:COLUMBUS
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-5720
Mailing Address - Country:US
Mailing Address - Phone:812-379-9893
Mailing Address - Fax:812-379-9904
Practice Address - Street 1:1130 WASHINGTON ST
Practice Address - Street 2:COLUMBUS
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5720
Practice Address - Country:US
Practice Address - Phone:812-379-9893
Practice Address - Fax:812-379-9904
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD869152W00000X
IN18003363A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200527540Medicaid
IN062550OtherSIHO
INV05684Medicare UPIN
IN0196300001Medicare NSC
IN229970Medicare ID - Type Unspecified