Provider Demographics
NPI:1770773707
Name:REPKO, MELISSA GAIL (OD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:GAIL
Last Name:REPKO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:241 GATEWAY PLZ
Mailing Address - Street 2:SUITE 106
Mailing Address - City:GATE CITY
Mailing Address - State:VA
Mailing Address - Zip Code:24251-3350
Mailing Address - Country:US
Mailing Address - Phone:276-690-2345
Mailing Address - Fax:276-690-2345
Practice Address - Street 1:241 GATEWAY PLZ
Practice Address - Street 2:SUITE 106
Practice Address - City:GATE CITY
Practice Address - State:VA
Practice Address - Zip Code:24251-3350
Practice Address - Country:US
Practice Address - Phone:276-690-2345
Practice Address - Fax:276-690-2345
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN2447152W00000X
VA0618001462152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAA806OtherPTAN
VA010128404Medicaid
VAVOO936Medicare UPIN