Provider Demographics
NPI:1760649529
Name:STIMPSON, MELANIE ANN
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:ANN
Last Name:STIMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:MELANIE
Other - Middle Name:ANN
Other - Last Name:REIMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:2149 VELP AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-5424
Mailing Address - Country:US
Mailing Address - Phone:920-434-3767
Mailing Address - Fax:920-434-8128
Practice Address - Street 1:2149 VELP AVE
Practice Address - Street 2:STE 100
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-5424
Practice Address - Country:US
Practice Address - Phone:920-434-3767
Practice Address - Fax:920-434-8128
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1900035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38524200Medicaid
WI38524200Medicaid