Provider Demographics
NPI:1780634873
Name:KILLION, MELISSA JEAN (OD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:JEAN
Last Name:KILLION
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 1:9701 VENTNOR AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:MARGATE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08402-2222
Mailing Address - Country:US
Mailing Address - Phone:609-822-4242
Mailing Address - Fax:609-822-3211
Practice Address - Street 1:9701 VENTNOR AVE STE 201
Practice Address - Street 2:
Practice Address - City:MARGATE CITY
Practice Address - State:NJ
Practice Address - Zip Code:08402-2222
Practice Address - Country:US
Practice Address - Phone:609-822-4242
Practice Address - Fax:609-822-3211
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00575000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH8788201Medicaid
NJ052586L9QMedicare ID - Type Unspecified
NH8788201Medicaid