Provider Demographics
NPI:1730163601
Name:ERICKSON, MELISSA BARNETT (OD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:BARNETT
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:BARNETT
Other - Last Name:ERICKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2019 ANDERSON RD STE C
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-0773
Mailing Address - Country:US
Mailing Address - Phone:530-756-5050
Mailing Address - Fax:530-204-5995
Practice Address - Street 1:2019 ANDERSON RD STE C
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-0773
Practice Address - Country:US
Practice Address - Phone:530-756-5050
Practice Address - Fax:530-204-5995
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT11604T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0116041Medicare PIN
CAO86366Medicare UPIN