Provider Demographics
NPI:1609096478
Name:SUMMERFIELD, MELISSA M
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:SUMMERFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:M
Other - Last Name:MANNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1877
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50402-1877
Mailing Address - Country:US
Mailing Address - Phone:641-423-8861
Mailing Address - Fax:641-423-0727
Practice Address - Street 1:3121 4TH ST SW
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-1581
Practice Address - Country:US
Practice Address - Phone:757-423-8861
Practice Address - Fax:757-423-0727
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101247778207W00000X
IA39755207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA415451OtherANTHEM BC/BS
NC5915878Medicaid
VAPAROtherUSA MANAGED CARE
VAPAROtherCORVEL/CORCARE
VAPAROtherFIRST HEALTH COMMERCIAL/COVENTRY HEALTH/SOUTHERN HEALTH
VAPAROtherVIRGINIA PREMIER HEALTH PLAN
VAPAROtherCIGNA
VAPAROtherAETNA
VA-019OtherTRICARE/CHAMPUS
VA1609096478Medicaid
VAPAROtherUNITED HEALTH CARE/MAMSI
VAPAROtherMULTIPLAN
VAPAROtherVIRGINIA HEALTH NETWORK
VA10064693OtherOPTIMA HEALTH
VAVAA102875Medicare PIN