Provider Demographics
NPI:1134804891
Name:LINDOW, MELISSA TATE (OD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:TATE
Last Name:LINDOW
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:TATE
Other - Last Name:LINDOW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:31978 AVENIDA ENRIQUE
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-2145
Mailing Address - Country:US
Mailing Address - Phone:951-795-2544
Mailing Address - Fax:
Practice Address - Street 1:3434 4TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4911
Practice Address - Country:US
Practice Address - Phone:619-222-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35455152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist