Provider Demographics
NPI:1205997178
Name:VETTER, MELISSA RUTAN (OD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:RUTAN
Last Name:VETTER
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 1:2118 ARLINGTON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-4314
Mailing Address - Country:US
Mailing Address - Phone:614-273-2020
Mailing Address - Fax:
Practice Address - Street 1:2118 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:UPPER ARLINGTON
Practice Address - State:OH
Practice Address - Zip Code:43221-4314
Practice Address - Country:US
Practice Address - Phone:614-487-1022
Practice Address - Fax:614-487-1030
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4045152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT86562Medicare UPIN