Provider Demographics
NPI:1245309228
Name:VEGA, MELODY F (OPTICIAN)
Entity type:Individual
Prefix:MS
First Name:MELODY
Middle Name:F
Last Name:VEGA
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:MS
Other - First Name:MELODIA
Other - Middle Name:F
Other - Last Name:VEGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OPTICIAN
Mailing Address - Street 1:605 E IMPERIAL HWY STE C
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5627
Mailing Address - Country:US
Mailing Address - Phone:714-257-1660
Mailing Address - Fax:714-257-1662
Practice Address - Street 1:605 E IMPERIAL HWY STE C
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5627
Practice Address - Country:US
Practice Address - Phone:714-257-1660
Practice Address - Fax:714-257-1662
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASL1397156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA421585746OtherUFCW
CA0205OtherNVA
CA39044OtherAVESIS
CA421585746OtherPRINCIPAL LIFE INS
CA34718OtherDAVIS VISION
CACA 7663OtherEYEMED VSION
CA190540OtherVSION PLAN OF AMERICA
CAPPO62133 HMO62134OtherSAFEGUARD VISION
CA42415OtherMES
CAVS28OtherSMILE SAVER
CA3165OtherCOAST TO COAST VISION
CA421585746OtherSUPERIOR VISION PLAN
CAST211441OtherCLARITY VISION
CA421585746OtherBLUE CROSS OF CA
CA421585746OtherCIGNA
CA421585746OtherGREAT WEST INSURANCE
CA73292OtherUNITED HEALTH CARE/SPECTERA