Provider Demographics
NPI:1952330714
Name:METZGER-ROMATZ, MELISSA LEA (OD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LEA
Last Name:METZGER-ROMATZ
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 1:21 PARK PL
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-8872
Mailing Address - Country:US
Mailing Address - Phone:920-739-4361
Mailing Address - Fax:920-739-6368
Practice Address - Street 1:21 PARK PL
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-8872
Practice Address - Country:US
Practice Address - Phone:920-739-4361
Practice Address - Fax:920-739-6368
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI2602152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38592400Medicaid
WI38592400Medicaid
WI000745140Medicare PIN