Provider Demographics
NPI:1801821616
Name:BELL, MELISSA M (OD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:BELL
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 1:1910 IDAHO ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-2564
Mailing Address - Country:US
Mailing Address - Phone:208-743-4022
Mailing Address - Fax:
Practice Address - Street 1:1910 IDAHO ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2564
Practice Address - Country:US
Practice Address - Phone:208-743-4022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-1020152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID410044377OtherRAIL ROAD MEDICARE
OR410044613OtherRAIL ROAD MEDICARE
WA410044616OtherRAIL ROAD MEDICARE
WA410044614OtherRAIL ROAD MEDICARE
WA410044615OtherRAIL ROAD MEDICARE
WAGAB18720Medicare PIN
WAGAB18622Medicare PIN
ORR136379Medicare PIN
WAGAB18723Medicare PIN
ID1593664Medicare PIN
WAGAB18722Medicare PIN
WAGAB18643Medicare PIN
U82591Medicare UPIN
WA410044616OtherRAIL ROAD MEDICARE