Provider Demographics
NPI:1679658843
Name:QUENZER, MELODY ORENE (OD)
Entity Type:Individual
Prefix:DR
First Name:MELODY
Middle Name:ORENE
Last Name:QUENZER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 GATEWAY DR STE 130
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-3303
Mailing Address - Country:US
Mailing Address - Phone:916-434-6225
Mailing Address - Fax:916-434-6023
Practice Address - Street 1:100 GATEWAY DR STE 130
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-3303
Practice Address - Country:US
Practice Address - Phone:916-434-6225
Practice Address - Fax:916-434-6023
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA11338T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAR233AMedicare PIN
0283680001Medicare NSC
U85219Medicare UPIN