Provider Demographics
NPI:1801855515
Name:MOGAVERO, MELISSA (OD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:MOGAVERO
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 1:2921 ERIE BLVD E
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224
Mailing Address - Country:US
Mailing Address - Phone:315-445-7465
Mailing Address - Fax:315-445-7675
Practice Address - Street 1:418 B BALLTOWN RD
Practice Address - Street 2:MOHAWK COMMONS EMPIRE VISION CENTERS
Practice Address - City:SCHEWECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304
Practice Address - Country:US
Practice Address - Phone:518-346-6290
Practice Address - Fax:518-346-6293
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT0067861152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V01727Medicare UPIN
NYRA4650Medicare PIN
NYRA4649Medicare ID - Type Unspecified
NYRA4652Medicare PIN
NYRA4651Medicare PIN