Provider Demographics
NPI:1851656904
Name:DR. MELANIE N. FELICIANO - OPTOMETRY INC.
Entity Type:Organization
Organization Name:DR. MELANIE N. FELICIANO - OPTOMETRY INC.
Other - Org Name:FOCUS OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FELICIANO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:650-218-0909
Mailing Address - Street 1:1005 WAYNE WAY
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-1562
Mailing Address - Country:US
Mailing Address - Phone:650-525-9139
Mailing Address - Fax:
Practice Address - Street 1:1098 FOSTER CITY BLVD
Practice Address - Street 2:105
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-2300
Practice Address - Country:US
Practice Address - Phone:650-345-2020
Practice Address - Fax:650-345-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12572T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGI093AMedicare PIN