Provider Demographics
NPI:1184693095
Name:MELZER, DOUGLAS CARL (OD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:CARL
Last Name:MELZER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13140 NE HALSEY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-2350
Mailing Address - Country:US
Mailing Address - Phone:503-253-7278
Mailing Address - Fax:503-253-0279
Practice Address - Street 1:13140 NE HALSEY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-2350
Practice Address - Country:US
Practice Address - Phone:503-253-7278
Practice Address - Fax:503-253-0279
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1931 - AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR810438002OtherBLUE CROSS
OR300365202OtherFIRST CHOICE 65
OR043422Medicaid
OR00WCNBDBMedicare PIN
OR300365202OtherFIRST CHOICE 65