Provider Demographics
NPI:1952467128
Name:MELTZER, PHILIP (OD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:MELTZER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2978 HEWLETT AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-5311
Mailing Address - Country:US
Mailing Address - Phone:516-867-2020
Mailing Address - Fax:516-487-2581
Practice Address - Street 1:80 MIDDLE NECK RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-1243
Practice Address - Country:US
Practice Address - Phone:516-487-3074
Practice Address - Fax:516-487-2581
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT-004437-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT86808Medicare UPIN