Provider Demographics
NPI:1942296595
Name:MOELLER, MELISSA CHARLOTTE (OD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:CHARLOTTE
Last Name:MOELLER
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 1:15337 SOUTHWEST FWY
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3832
Mailing Address - Country:US
Mailing Address - Phone:281-242-2020
Mailing Address - Fax:281-565-0888
Practice Address - Street 1:15337 SOUTHWEST FWY
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3832
Practice Address - Country:US
Practice Address - Phone:281-242-2020
Practice Address - Fax:281-565-0888
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5432TG152W00000X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0435349-01Medicaid
TX84T735Medicare ID - Type Unspecified
TX0574080001Medicare NSC
TXU66922Medicare UPIN