Provider Demographics
NPI:1184621005
Name:LINDERER, MELANIE LYNN (OD)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:LYNN
Last Name:LINDERER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:LYNN
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-1636
Mailing Address - Country:US
Mailing Address - Phone:816-781-2100
Mailing Address - Fax:816-781-2106
Practice Address - Street 1:6708 RAYTOWN ROAD
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133
Practice Address - Country:US
Practice Address - Phone:816-353-1872
Practice Address - Fax:816-353-5022
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO2003015398152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0060721OtherTRICARE PROVIDER NUMBER
MODC3193OtherMEDICARE RAILROAD GROUP #
MOP00205607OtherMEDICARE RAILROAD PIN
MO337219710OtherBNDD NUMBER
MOMO2003015398OtherSTATE LICENSE NUMBER
MO33475028OtherBCBS NUMBER
MOU96755Medicare UPIN
MOR73C677Medicare PIN
MOML1053052OtherDEA NUMBER