Provider Demographics
NPI:1790482719
Name:RODRIGUEZ, MELISSA (LDO)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4004 TUSCARAWAS ST W
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-5503
Mailing Address - Country:US
Mailing Address - Phone:330-479-9750
Mailing Address - Fax:330-479-9752
Practice Address - Street 1:4004 TUSCARAWAS ST W
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-5503
Practice Address - Country:US
Practice Address - Phone:330-479-9750
Practice Address - Fax:330-479-9752
Is Sole Proprietor?:No
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10268SC156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician