Provider Demographics
NPI:1245266998
Name:ERNST BRENOT, MELISSA A
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:A
Last Name:ERNST BRENOT
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:A
Other - Last Name:ERNST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:860 ROUTE 134 STE 8
Mailing Address - Street 2:
Mailing Address - City:SOUTH DENNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02660-2577
Mailing Address - Country:US
Mailing Address - Phone:508-394-2211
Mailing Address - Fax:508-398-4471
Practice Address - Street 1:860 ROUTE 134 STE 8
Practice Address - Street 2:
Practice Address - City:SOUTH DENNIS
Practice Address - State:MA
Practice Address - Zip Code:02660-2577
Practice Address - Country:US
Practice Address - Phone:508-394-2211
Practice Address - Fax:508-398-4471
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0662152W00000X
MAOPT5720152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHUX3345Medicare PIN