Provider Demographics
NPI:1891822581
Name:MCBRIEN, MELISSA TANBAKUCHI (OD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:TANBAKUCHI
Last Name:MCBRIEN
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 1:121 WASSAW CT
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-9205
Mailing Address - Country:US
Mailing Address - Phone:954-531-7838
Mailing Address - Fax:
Practice Address - Street 1:7330 OLD WAKE FOREST RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-3047
Practice Address - Country:US
Practice Address - Phone:919-792-2999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1969152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist