Provider Demographics
NPI:1760008619
Name:NIELSEN, MELANIE (OD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:MUSKEGO
Mailing Address - State:WI
Mailing Address - Zip Code:53150-0547
Mailing Address - Country:US
Mailing Address - Phone:262-679-1420
Mailing Address - Fax:414-422-0500
Practice Address - Street 1:S73W16437 JANESVILLE RD
Practice Address - Street 2:
Practice Address - City:MUSKEGO
Practice Address - State:WI
Practice Address - Zip Code:53150-9723
Practice Address - Country:US
Practice Address - Phone:414-422-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3621-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist