Provider Demographics
NPI:1801977889
Name:MELZER, MICHAEL D (OD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:MELZER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 LINCOLN DR W
Mailing Address - Street 2:SUITE E
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1534
Mailing Address - Country:US
Mailing Address - Phone:856-985-9797
Mailing Address - Fax:856-985-1191
Practice Address - Street 1:1001 LINCOLN DR W
Practice Address - Street 2:SUITE E
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1534
Practice Address - Country:US
Practice Address - Phone:856-985-9797
Practice Address - Fax:856-985-1191
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00437700152W00000X
NJ27OM00075900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0798304Medicaid
NJ0798304Medicaid
U17114Medicare UPIN
NJP00721529Medicare PIN