Provider Demographics
NPI:1689865180
Name:HULL, MELISSA JO (OD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JO
Last Name:HULL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:JO
Other - Last Name:HEDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:545 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-6321
Mailing Address - Country:US
Mailing Address - Phone:503-866-6857
Mailing Address - Fax:
Practice Address - Street 1:1815 SW EMIGRANT AVE
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-1843
Practice Address - Country:US
Practice Address - Phone:541-276-3653
Practice Address - Fax:541-966-4322
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3235ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR3235ATIOtherOD LICENSE