Provider Demographics
NPI:1952672388
Name:MASEK, MELISSA ANN LIEPINS (OD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ANN LIEPINS
Last Name:MASEK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:LIEPINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4004 CHATSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6815
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 N KEENE ST
Practice Address - Street 2:SUITE 103
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8104
Practice Address - Country:US
Practice Address - Phone:573-874-2030
Practice Address - Fax:573-449-0253
Is Sole Proprietor?:No
Enumeration Date:2012-01-17
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010451152W00000X
MO2011037693152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO152360645Medicare PIN