Provider Demographics
NPI:1871829457
Name:LEMERY, ELYSE MELANIE (OD)
Entity Type:Individual
Prefix:DR
First Name:ELYSE
Middle Name:MELANIE
Last Name:LEMERY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5455 BELT LINE RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-1501
Mailing Address - Country:US
Mailing Address - Phone:972-980-1774
Mailing Address - Fax:972-980-0650
Practice Address - Street 1:5455 BELT LINE RD
Practice Address - Street 2:SUITE 150
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-1501
Practice Address - Country:US
Practice Address - Phone:972-980-1774
Practice Address - Fax:972-980-0650
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6500TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB101817Medicare UPIN