Provider Demographics
NPI:1821657016
Name:OGDEN, MELISSA JANE (OD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JANE
Last Name:OGDEN
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 1:4018 CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-3424
Mailing Address - Country:US
Mailing Address - Phone:703-671-1188
Mailing Address - Fax:
Practice Address - Street 1:4018 CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-3424
Practice Address - Country:US
Practice Address - Phone:703-671-1188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002776152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist