Provider Demographics
NPI:1205887171
Name:DAVID, MELISSA MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:MARIE
Last Name:DAVID
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 WHEELER RD
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-9483
Mailing Address - Country:US
Mailing Address - Phone:989-684-1330
Mailing Address - Fax:
Practice Address - Street 1:2489 TRAUTNER DR
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-9596
Practice Address - Country:US
Practice Address - Phone:989-791-2020
Practice Address - Fax:989-791-2083
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003962152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900Z965110OtherBLUE CROSS BLUE SHIELD
MIA78869Medicare UPIN
MIP15550002Medicare PIN
MI5650800001Medicare NSC