Provider Demographics
NPI:1992011506
Name:RASMUSSEN, MELISSA L (OD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:L
Last Name:RASMUSSEN
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 1:1185 HART ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-4805
Mailing Address - Country:US
Mailing Address - Phone:601-605-2259
Mailing Address - Fax:601-856-0195
Practice Address - Street 1:1185 HART ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-4805
Practice Address - Country:US
Practice Address - Phone:601-605-2259
Practice Address - Fax:601-856-0195
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS818152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist