Provider Demographics
NPI:1992205363
Name:MACCO, MELISSA D (OD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:D
Last Name:MACCO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Mailing Address - Street 1:3524 HERONS CIR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-7793
Mailing Address - Country:US
Mailing Address - Phone:510-491-5316
Mailing Address - Fax:775-359-2676
Practice Address - Street 1:285 W MOANA LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4905
Practice Address - Country:US
Practice Address - Phone:775-826-2477
Practice Address - Fax:775-826-1524
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-13
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV1012152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33882TLGOtherSTATE LICENSE
NV1012OtherSTATE LICENSE