Provider Demographics
NPI:1457904765
Name:OTERO, MELISSA (OD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:OTERO
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 1:4330 SHERIDAN ST # 102-B
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-1407
Mailing Address - Country:US
Mailing Address - Phone:954-287-2010
Mailing Address - Fax:305-723-1910
Practice Address - Street 1:4330 SHERIDAN ST STE 102B
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-1407
Practice Address - Country:US
Practice Address - Phone:954-287-2010
Practice Address - Fax:305-723-1910
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-17
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5671152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist