Provider Demographics
NPI:1023090420
Name:MCCRACKEN, MELISSA A (OD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:A
Last Name:MCCRACKEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:A
Other - Last Name:CARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:27 PORTER AVE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701
Mailing Address - Country:US
Mailing Address - Phone:716-483-2020
Mailing Address - Fax:716-488-9295
Practice Address - Street 1:27 PORTER AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701
Practice Address - Country:US
Practice Address - Phone:716-483-2020
Practice Address - Fax:716-488-9295
Is Sole Proprietor?:No
Enumeration Date:2005-11-19
Last Update Date:2022-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007263-1152W00000X
PAOEG001485152W00000X
NYTUV007263152W00000X
PAOEG1485152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102161282Medicaid
NY03029196Medicaid
PA081250E41Medicare PIN
PA102161282Medicaid
NY0399350003Medicare NSC
PA0399350003Medicare NSC